992 resultados para Cochlea - anatomy
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Mestrado em Segurana e Higiene no Trabalho
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Introduo: A capacidade auditiva dos doentes com neoplasias de cabea e pescoo e tumores cerebrais pode ser comprometida com os tratamentos antineoplsicos realizados. A Quimioterapia com cisplatina pode provocar perda auditiva de conduo ou neurossensorial, podendo agravar-se quando combinada com Radioterapia (RT). O objectivo deste trabalho foi a anlise da relao entre a Terapia Combinada (Cisplatina+RT) e a Radioterapia isolada, e os seus efeitos adversos sobre a audio tendo em considerao a incluso das estruturas do ouvido no campo de tratamento de RT. Mtodos: Foram seguidos 10 doentes submetidos a Terapia Combinada (grupo TC) e 11 a Radioterapia isolada (grupo RT). A avaliao audiolgica realizou-se antes do inicio (M1), no fim (M2) e um ms aps (M3) o termo dos tratamentos e incluiu anamnese audiolgica, otoscopia e audiometria tonal. Resultados: No grupo TC, 94,4% dos doentes apresentaram uma relao directamente proporcional entre a dose de radiao na cclea e a perda auditiva. Esta relao s se verificou em 31% dos doentes do grupo RT, tendo-se verificado diferenas significativas entre grupos (p <0,001). Concluses: Verificou-se maior incidncia da perda auditiva no grupo TC relativamente ao grupo RT. Sugere-se um melhor planeamento do tratamento de RT, reduz - indo a dose cclea com o objectivo de minimizar a perda auditiva neurossensorial irreversvel, sobretudo quando so utilizadas as duas modalidades de tratamento.
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The synthetic study of the uppermost Cretaceous of the Beira Litoral (fauna, flora) confirms its upper Campanian-Maastrichtian age. It shows the presence of a tropical to subtropical climate in an area constituted by a low coastal plain only occasionally linked to the sea, saturated with fresh water and possessing accordingly, a predominantely freshwater fauna (Viso, Aveiro); this plain changed towards the interior into a drier more forested zone with a more abundant terrestrial fauna which includes mammals (Taveiro). A thorough study of the chelonian Rosasia, abundant on the coastal plain, was made possible thanks to the discovery of a skull: it demonstrates that the genus belongs to the family Bothremydidae, revalided here. The composition of this family is presented, its phylogenetic and paleobiogeographic relation with the other pleurodires are analyzed, and its diagnosis established. The family is constituted of three groups; Rosasia belongs to one of these, the Bothremys group.
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The foot and the ankle are small structures commonly affected by disorders, and their complex anatomy represent significant diagnostic challenges. SPECT/CT Image fusion can provide missing anatomical and bone structure information to functional imaging, which is particularly useful to increase diagnosis certainty of bone pathology. However, due to SPECT acquisition duration, patients involuntary movements may lead to misalignment between SPECT and CT images. Patient motion can be reduced using a dedicated patient support. We aimed at designing an ankle and foot immobilizing device and measuring its efficacy at improving image fusion. Methods: We enrolled 20 patients undergoing distal lower-limb SPECT/CT of the ankle and the foot with and without a foot holder. The misalignment between SPECT and CT images was computed by manually measuring 14 fiducial markers chosen among anatomical landmarks also visible on bone scintigraphy. Analysis of variance was performed for statistical analysis. Results: The obtained absolute average difference without and with support was 5.15.2 mm (meanSD) and 3.12.7 mm, respectively, which is significant (p<0.001). Conclusion: The introduction of the foot holder significantly decreases misalignment between SPECT and CT images, which may have clinical influence in the precise localization of foot and ankle pathology.
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When performing a full calculation within the standard model (SM) or its extensions, it is crucial that one utilizes a consistent set of signs for the gauge couplings and gauge fields. Unfortunately, the literature is plagued with differing signs and notations. We present all SM Feynman rules, including ghosts, in a convention-independent notation, and we table the conventions in close to 40 books and reviews.
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The synthetic study of the uppermost Cretaceous of the Beira Litoral (fauna, floral confirms its upper Campanian-Maastrichtian age. It shows the presence of a tropical to subtropical climate in an area constituted by a low coastal plain only occasionally linked to the sea, saturared with fresh water and possessing accordingly, a predominantely freshwater fauna (Viso, Aveiro); this plain changed towards the interior into a drier more forested zone with a more abundant terrestrial fauna which includes mammals (Taveiro). A thorough study of the chelonian Rosasia, abundant on the coastal plain, was made possible thanks to the discovery of a skull: it demonstrates that the genus belongs to the family Bothremydidae, revalided here. The composition of this family is presented, its phylogenetic and paleobiogeographic relation with the other pleurodires are analyzed, and its diagnosis established. The family is constituted of three groups; Rosasia belongs to one of rhese, the Bothremys group.
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RESUMO Os trabalhos de investigao, conducentes elaborao do presente estudo morfofuncional, subordinado ao tema da "VASCULARIZAO ARTERIAL DO TERO",fundamenta-se em conceitos da anatomia descritiva clssica, complementados por tcnicas de estudo mais modernas, permitindo-nos observaes originais. O principal objectivo de definir um padro descritivo da vascularizao uterina e de estabelecer uma correlao anatomo-fisiolgica e anatomo-clnica na descrio da angiomorfologia uterina, actualizando as descries clssicas da artria com dados de observao originais, segundo as tcnicas de estudo angiomorfolgicas correntemente empregues no Departamento de Anatomia da Faculdade de Cincias Mdicas da Universidade Nova de Lisboa. Correlacionam-se as observaes com os mais recentes dados publicados, no mbito da imuno-histoqumica e da moderna bioqumica endocrinolgica, uma vez que os conceitos modernos de fisiologia uterina e ginecolgica praticamente dominam a vasta literatura cientfica mundial. Como objectivos particulares, ou linhas orientadoras da tese, escolhemos: - A definio de parmetros descritivos do padro genrico da vascularizao uterina, actualizando a nomenclatura descritiva de acordo com a moderna Nomina Anatomica mundialmente debatida, desde o XIV Congresso Internacional da Federao Internacional das Associaes de Anatomistas, sob a presidncia do Prof. Doutor J.A. Esperana Pina (1994) e publicada em 1999-2001. - A comparao do caso humano com o do animal de experincia, por observao meticulosa do maior nmero de casos possveis, realizando um estudo comparativo que nos permita extrapolar dados de experimentao animal para o caso humano; - O estabelecimento de uma correlao anatomo-fisiolgica, por anlise do comportamento da vascularizao uterina, ao longo da vida, desde o nascimento at menopausa, e perante as influncias hormonais a que se encontra exposta. A tese constri-se em torno de trs ncleos fundamentais: 1. Um captulo introdutrio, de contextualizao terica, por enquadramento histrico dos estudos dos rgos genitais femininos e da evoluo das tcnicas de diagnstico e teraputica do tero, focando as primeiras referncias tcnica da histerotomia (Cesariana) (com a lenda persa do nascimento do heri Rostam, ou do nascimento do deus Asclepius), as primeiras representaes da vascularizao uterina (por LEONARDO e iii VESLIO), ou as primeiras descries anatmicas do tero, da autoria de Portugueses (RODRIGO DE CASTRO, 1516 e AMATO LUSITANO, 1551). Prossegue a contextualizao terica com breve referncia recente evoluo das tcnicas de diagnstico e teraputica dos fibromiomas uterinos, mencionando de modo particular a evoluo das tcnicas de embolizao arterial uterina, por nos parecer corresponder a um campo de aplicao imediata dos estudos da vascularizao do tero. Termina este captulo com breve referncia aos trabalhos do Prof. Doutor J. MARTINS PISCO que tem actualmente, no nosso Pas uma das mais extensas listas de trabalhos efectuados com sucesso a nvel mundial, no campo da embolizao arterial de fibromiomas uterinos. 2. O segundo ncleo fundamental, intitulado "Angiomorfologia uterina" corresponde a extensa reviso bibliogrfica dos estudos descritivos da vascularizao uterina, desde logo ilustrando a resenha terica com algumas imagens fotogrficas de teros humanos, seleccionadas da nossa coleco. A descrio da vascularizao uterina, fundamentada em 1500 citaes bibliogrficas, organiza-se, de acordo com o paralelismo entre a estratificao histolgica e angiolgica do rgo, e a hierarquia funcional, regulada pelas cclicas variaes hormonais. Descreve-se a camada serosa e correspondente vascularizao; a camada muscular e vascularizao do miomtrio; e, por fim, a camada mucosa e os vasos endometriais. Verifica-se, perante os dados colhidos da literatura mundial, o interesse do aprofundamento dos estudos morfolgicos da microvascularizao endometrial e da adaptao das descries aos resultados dos modernos estudos funcionais obtidos por tcnicas da imuno-histoqumica. 3. Fundamentados nos dados colhidos das revises bibliogrficas, elabormos um projecto de investigao original, visando o estabelecimento da relao morfo-funcional resultante do aprofundamento dos estudos descritivos da angiomorfologia e da microvascularizao do tero. O captulo de trabalho experimental organiza-se em trs principais passos: No captulo de Materiais e mtodos, procede-se escolha, por um lado do animal de experincia mais adequado para os estudos da vascularizao uterina (por estudo comparativo ao longo da escala animal) e, por outro lado, escolha de trs das tcnicas disponveis no Laboratrio de Anatomia Experimental e aplicveis investigao angiomorfolgica do tero; iv - No captulo de Resultados, procedemos exposio das nossas observaes de 25 teros humanos e de 154 teros de animais de experincia, segundo as trs tcnicas seleccionadas (disseco, Injeco-corroso-fluorescncia, Injeco-diafanizao e injeco-corroso paraobservao de moldes vasculares em microscopia electrnica de varrimento), organizando aseleco da vasta iconografia coleccionada em trs novos subcaptulos: o tero humano, otero do animal de experincia e um estudo comparativo, essencial para validar osresultados do trabalho experimental. - O captulo de trabalho experimental, inteiramente efectuado por estudos na artria uterina do rato Wistar, abrange primeiramente a tentativa de definio macroscpica de territrios de vascularizao, seguido das observaes microscpicas conducentes definio dos parmetros angiomorfolgicos caractersticos de cada uma das etapas da grande variabilidade a que se sujeita a vascularizao uterina, ao longo da vida, incluindo a infncia, a gravidez, a paridade e o envelhecimento, e consoante as fases do ciclo hormonal ovrico. Aperfeiomos essa tarefa com a elaborao de trs experincias distintas, para anlise dos efeitos microvasculares uterinos da administrao exgena de preparados comerciais hormonais, por observao em microscopia electrnica de varrimento. De acordo com as leituras da literatura clssica sobre a metodologia do trabalho cientfico, completamos os trabalhos por um captulo de sntese e critica dos resultados, sequencialmente organizado consoante cada um dos passos experimentais atrs referidos. SUMMARY The aim of the present thesis is the description of the uterine arterial network, complementing the classical concepts of descriptive Anatomy with modern techniques of anatomical research, thus achieving original final results and observations. One of the main objectives of the research is to establish physiological and clinical correlations in the description of the uterine angiomorphology, with the techniques currently available for angiomorphological research in the Department of Anatomy of Faculty of Medical Sciences of the New University of Lisbon. As guidelines to our research, we established the following specific objectives: - defining the descriptive parameters of the standard pattern of the uterine vasculature, according to the modern Nomina Anatomica, as underlined in the latest Federative Congresses of the International Federation of the Associations of Anatomists, one of which took place in Lisbon, in 1994, under the presidency of Professor J.A. Esperana Pina, the supervisor of the present works; - comparing the human uterus with the uterus of the experimental animal, to extrapolate the experimental observations in animals to the particular case of the human uterus; - establishing a correlation between the physiology and the anatomical observations of the uterine vasculature throughout life, from childhood to menopause and in relation to the hormonal influences to which the uterus is exposed. The thesis is built around three main chapters: 1) The introduction chapter defines the historical framework of the studies of the female genital anatomy and the historical evolution of the clinical management of common uterine diseases, focusing on the first historical references to the Caesarean section (such as the Persian legend of the birth of the hero ROSTAM, or that of the birth of ASCLEPIUS, the Greek god of Medicine); the first depictions of the uterine vasculature (by LEONARDO and VESALIUS) or the first anatomical descriptions of the uterus, by Portuguese authors (RODRIGO DE CASTRO, 1517, or AMATUS LUSITANUS, 1551). The theoretical context proceeds, with reference to the recent evolution of the clinical and surgical management of uterine fibroids, and a particular mention to the modern techniques of Uterine Fibroid Embolisation, which corresponds to one of the fields of interest of the anatomic studies of uterine arterial vascularization. 2) The second chapter, devoted to the anatomical description of the Uterine Angiomorphology, is based on an extensive review of the available Medical literature,illustrated by a selection of our own research observations of the human uterine vasculature. The description is organized in view of the parallelism between histological and angiological stratification and the functional hierarchy, under the control of the cyclic hormonal variations. Each layer of the uterine wall is depicted with photographs of the human uterus and descriptions of its specific vascular network: the serosa, the muscular Myometrium, and the mucosa, or endometrium. This classical description, based on extensive quotations of the international scientific literature, enhances our interest for the research of a more detailed knowledge of the endometrial microvascular network, accordingly to the modern physiologic results obtained through immunohistochemical studies. 3) The results of our experimental research, aiming to establish the intimate relationship between the anatomical and functional studies of uterine vasculature, are organized in three main steps: - The chapter of Materials and Methods debates the choice of the experimental animal, based on a short review of the comparative anatomy of the uterus, and uterine physiology, throughout the animal scale. The selection of three fundamental techniques of anatomic research is made from the current variety available in the Laboratory of Experimental Anatomy of the Lisbon School of Medical Sciences. - The Results of our personal research and observations of 25 human and 154 animal uteri,after dissection, and the techniques of arterial injection for the preparation of fluorescent corrosion casts, of vascular injection and clearing, and of arterial injection and preparation of corrosion casts for Scanning Electron Microscopy are rganized in terms of human or animal macroscopic anatomy and microvascular network, followed by a summary of the comparative anatomy of human and rat uteri, which is essential to validate the resultant experimental observations of the rat endometrial microvasculature. - The experimental research is entirely devoted to the uterine artery of the Wistar rat. The first step consists of the attempt to define macroscopic territories of vascularization, followed by microscopic observations for the definition of the angiomorphological pattern that is characteristic of each stage of the extreme variations to which the uterus is subject throughout life, from childhood to sexual maturity, throughout the hormonal cycle, in pregnancy, according to parity, and through ageing. We complete these observations with the experimental exposure of the Wistar rat uterus to pharmacologic preparations of hormones, currently available in clinical practice, and observations of the vascular uterine changes in Scanning Electron Microscopy. The outcome results of our anatomical observations are followed by a critical synthesis of the results.
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RESUMO - A exposio a formaldedo reconhecidamente um dos mais importantes factores de risco presente nos laboratrios hospitalares de anatomia patolgica. Neste contexto ocupacional, o formaldedo utilizado em soluo, designada comummente por formol. Trata-se de uma soluo comercial de formaldedo, normalmente diluda a 10%, sendo pouco onerosa e, por esse motivo, a eleita para os trabalhos de rotina em anatomia patolgica. A soluo utilizada como fixador e conservante do material biolgico, pelo que as peas anatmicas a serem processadas so previamente impregnadas. No que concerne aos efeitos para a sade do formaldedo, os efeitos locais parecem apresentar um papel mais importante comparativamente com os efeitos sistmicos, devido sua reactividade e rpido metabolismo nas clulas da pele, tracto gastrointestinal e pulmes. Da mesma forma, a localizao das leses correspondem principalmente s zonas expostas s doses mais elevadas deste agente qumico, ou seja, o desenvolvimento dos efeitos txicos depender mais da intensidade da dose externa do que da durao da exposio. O efeito do formaldedo no organismo humano mais facilmente detectvel a aco irritante, transitria e reversvel sobre as mucosas dos olhos e aparelho respiratrio superior (naso e orofaringe), o que acontece em geral para exposies frequentes e superiores a 1 ppm. Doses elevadas so citotxicas e podem conduzir a degenerescncia e necrose das mucosas e epitlios. No que concerne aos efeitos cancergenos, a primeira avaliao efectuada pela International Agency for Research on Cancer data de 1981, actualizada em 1982, 1987, 1995 e 2004, considerando-o como um agente cancergeno do grupo 2A (provavelmente carcinognico). No entanto, a mais recente avaliao, em 2006, considera o formaldedo no Grupo 1 (agente carcinognico) com base na evidncia de que a exposio a este agente susceptvel de causar cancro nasofarngeo em humanos. Constituiu objectivo principal deste estudo caracterizar a exposio profissional a formaldedo nos laboratrios hospitalares de anatomia patolgica Portugueses. Pretendeu-se, ainda, descrever os fenmenos ambientais da contaminao ambiental por formaldedo e explorar eventuais associaes entre variveis. Considerou-se uma amostra de 10 laboratrios hospitalares de anatomia patolgica, avaliada a exposio dos trs grupos profissionais por comparao com os dois referenciais de exposio e, ainda, conhecidos os valores de concentrao mxima em 83 actividades. Foram aplicados simultaneamente dois mtodos distintos de avaliao ambiental: um dos mtodos (Mtodo 1) fez uso de um equipamento de leitura directa com o princpio de medio por Photo Ionization Detection, com uma lmpada de 11,7 eV e, simultaneamente, realizou-se o registo da actividade. Este mtodo disponibilizou dados para o referencial de exposio da concentrao mxima; o outro mtodo (Mtodo 2) traduziu-se na aplicao do mtodo NIOSH 2541, implicando o uso de bombas de amostragem elctricas de baixo caudal e posterior processamento analtico das amostras por cromatografia gasosa. Este mtodo, por sua vez, facultou dados para o referencial de exposio da concentrao mdia ponderada. As estratgias de medio de cada um dos mtodos e a definio dos grupos de exposio existentes neste contexto ocupacional, designadamente os Tcnicos de Anatomia Patolgica, os Mdicos Anatomo-Patologistas e os Auxiliares, foram possveis atravs da informao disponibilizada pelas tcnicas de observao da actividade da anlise (ergonmica) do trabalho. Estudaram-se diversas variveis independentes, nomeadamente a temperatura ambiente e a humidade relativa, a soluo de formaldedo utilizada, as condies de ventilao existentes e o nmero mdio de peas processadas por dia em cada laboratrio. Para a recolha de informao sobre estas variveis foi preenchida, durante a permanncia nos laboratrios estudados, uma Grelha de Observao e Registo. Como variveis dependentes seleccionaram-se trs indicadores de contaminao ambiental, designadamente o valor mdio das concentraes superiores a 0,3 ppm em cada laboratrio, a Concentrao Mdia Ponderada obtida para cada grupo de exposio e o ndice do Tempo de Regenerao de cada laboratrio. Os indicadores foram calculados e definidos atravs dos dados obtidos pelos dois mtodos de avaliao ambiental aplicados. Baseada no delineado pela Universidade de Queensland, foi ainda aplicada uma metodologia de avaliao do risco de cancro nasofarngeo nas 83 actividades estudadas de modo a definir nveis semi-quantitativos de estimao do risco. Para o nvel de Gravidade considerou-se a informao disponvel em literatura cientfica que define eventos biolgicos adversos, relacionados com o modo de aco do agente qumico e os associa com concentraes ambientais de formaldedo. Para o nvel da Probabilidade utilizou-se a informao disponibilizada pela anlise (ergonmica) de trabalho que permitiu conhecer a frequncia de realizao de cada uma das actividades estudadas. A aplicao simultnea dos dois mtodos de avaliao ambiental resultou na obteno de resultados distintos, mas no contraditrios, no que concerne avaliao da exposio profissional a formaldedo. Para as actividades estudadas (n=83) verificou-se que cerca de 93% dos valores so superiores ao valor limite de exposio definido para a concentrao mxima (VLE-CM=0,3 ppm). O exame macroscpico foi a actividade mais estudada e onde se verificou a maior prevalncia de resultados superiores ao valor limite (92,8%). O valor mdio mais elevado da concentrao mxima (2,04 ppm) verificou-se no grupo de exposio dos Tcnicos de Anatomia Patolgica. No entanto, a maior amplitude de resultados observou-se no grupo dos Mdicos Anatomo-Patologistas (0,21 ppm a 5,02 ppm). No que respeita ao referencial da Concentrao Mdia Ponderada, todos os valores obtidos nos 10 laboratrios estudados para os trs grupos de exposio foram inferiores ao valor limite de exposio definido pela Occupational Safety and Health Administration (TLV-TWA=0,75 ppm). Verificou-se associao estatisticamente significativa entre o nmero mdio de peas processadas por laboratrio e dois dos trs indicadores de contaminao ambiental utilizados, designadamente o valor mdio das concentraes superiores a 0,3 ppm (p=0,009) e o ndice do Tempo de Regenerao (p=0,001). Relativamente temperatura ambiente no se observou associao estatisticamente significativa com nenhum dos indicadores de contaminao ambiental utilizados. A humidade relativa apresentou uma associao estatisticamente significativa apenas com o indicador de contaminao ambiental da Concentrao Mdia Ponderada de dois grupos de exposio, nomeadamente com os Mdicos Anatomo-Patologistas (p=0,02) e os Tcnicos de Anatomia Patolgica (p=0,04). A aplicao da metodologia de avaliao do risco nas 83 actividades estudadas permitiu verificar que, em cerca de dois teros (35%), o risco foi classificado como (pelo menos) elevado e, ainda, constatar que 70% dos laboratrios apresentou pelo menos 1 actividade com a classificao de risco elevado. Da aplicao dos dois mtodos de avaliao ambiental e das informaes obtidas para os dois referenciais de exposio pode concluir-se que o referencial mais adequado a Concentrao Mxima por estar associado ao modo de actuao do agente qumico. Acresce, ainda, que um mtodo de avaliao ambiental, como o Mtodo 1, que permite o estudo das concentraes de formaldedo e simultaneamente a realizao do registo da actividade, disponibiliza informaes pertinentes para a interveno preventiva da exposio por permitir identificar as actividades com a exposio mais elevada, bem como as variveis que a condicionam. As peas anatmicas apresentaram-se como a principal fonte de contaminao ambiental por formaldedo neste contexto ocupacional. Aspecto de particular interesse, na medida que a actividade desenvolvida neste contexto ocupacional e, em particular na sala de entradas, centrada no processamento das peas anatmicas. Dado no se perspectivar a curto prazo a eliminao do formaldedo, devido ao grande nmero de actividades que envolvem ainda a utilizao da sua soluo comercial (formol), pode concluir-se que a exposio a este agente neste contexto ocupacional especfico preocupante, carecendo de uma interveno rpida com o objectivo de minimizar a exposio e prevenir os potenciais efeitos para a sade dos trabalhadores expostos. ---------------- ABSTRACT - Exposure to formaldehyde is recognized as one of the most important risk factors present in anatomy and pathology laboratories from hospital settings. In this occupational setting, formaldehyde is used in solution, typically diluted to 10%, and is an inexpensive product. Because of that, is used in routine work in anatomy and pathology laboratories. The solution is applied as a fixative and preservative of biological material. Regarding formaldehyde health effects, local effects appear to have a more important role compared with systemic effects, due to his reactivity and rapid metabolism in skin, gastrointestinal tract and lungs cells. Likewise, lesions location correspond mainly to areas exposed to higher doses and toxic effects development depend more on external dose intensity than exposure duration. Human body formaldehyde effect more easily detectable is the irritating action, transient and reversible on eyes and upper respiratory tract (nasal and throat) membranes, which happen in general for frequent exposure to concentrations higher than 1 ppm. High doses are cytotoxic and can lead to degeneration, and also to mucous membranes and epithelia necrosis. With regard to carcinogenic effects, first assessment performed by International Agency for Research on Cancer in 1981, updated in 1982, 1987, 1995 and 2004, classified formaldehyde in Group 2A (probably carcinogenic). However, most recent evaluation in 2006, classifies formaldehyde carcinogenic (Group 1), based on evidence that exposure to this agent is likely to cause nasopharyngeal cancer in humans. This study principal objective was to characterize occupational exposure to formaldehyde in anatomy and pathology hospital laboratories, as well to describe formaldehyde environmental contamination phenomena and explore possible associations between variables. It was considered a sample of 10 hospital pathology laboratories, assessed exposure of three professional groups for comparison with two exposure metrics, and also knows ceiling concentrations in 83 activities. Were applied, simultaneously, two different environmental assessment methods: one method (Method 1) using direct reading equipment that perform measure by Photo Ionization Detection, with 11,7 eV lamps and, simultaneously, make activity description and film. This method provided data for ceiling concentrations for each activity study (TLV-C). In the other applied method (Method 2), air sampling and formaldehyde analysis were performed according to NIOSH method (2541). This method provided data average exposure concentration (TLV-TWA). Measuring and sampling strategies of each methods and exposure groups definition (Technicians, Pathologists and Assistants) was possible by information provided by activities (ergonomic) analysis. Several independent variables were studied, including temperature and relative humidity, formaldehyde solution used, ventilation conditions, and also anatomic pieces mean value processed per day in each laboratory. To register information about these variables was completed an Observation and Registration Grid. Three environmental contamination indicators were selected has dependent variables namely: mean value from concentrations exceeding 0,3 ppm in each laboratory, weighted average concentration obtained for each exposure group, as well each laboratory Time Regeneration Index. These indicators were calculated and determined through data obtained by the two environmental assessment methods. Based on Queensland University proposal, was also applied a methodology for assessing nasopharyngeal cancer risk in 83 activities studied in order to obtain risk levels (semi-quantitative estimation). For Severity level was considered available information in scientific literature that defines biological adverse events related to the chemical agent action mode, and associated with environment formaldehyde concentrations. For Probability level was used information provided by (ergonomic) work analysis that helped identifies activity frequency. Environmental assessment methods provide different results, but not contradictory, regarding formaldehyde occupational exposure evaluation. In the studied activities (n=83), about 93% of the values were above exposure limit value set for ceiling concentration in Portugal (VLE-CM = 0,3 ppm). "Macroscopic exam" was the most studied activity, and obtained the higher prevalence of results superior than 0,3 ppm (92,8%). The highest ceiling concentration mean value (2,04 ppm) was obtain in Technicians exposure group, but a result wider range was observed in Pathologists group (0,21 ppm to 5,02 ppm). Concerning Method 2, results from the three exposure groups, were all lower than limit value set by Occupational Safety and Health Administration (TLV-TWA=0,75ppm). There was a statistically significant association between anatomic pieces mean value processed by each laboratory per day, and two of the three environmental contamination indicators used, namely average concentrations exceeding 0,3 ppm (p=0,009) and Time Regeneration Index (p=0,001). Temperature was not statistically associated with any environmental contamination used indicators. Relative humidity had a statistically significant association only with one environmental contamination indicator, namely weighted average concentration, particularly with Pathologists group (p=0,02) and Technicians group (p=0,04). Risk assessment performed in the 83 studied activities showed that around two thirds (35%) were classified as (at least) high, and also noted that 70% of laboratories had at least 1 activity with high risk rating. The two environmental assessment methods application, as well information obtained from two exposure metrics, allowed to conclude that most appropriate exposure metric is ceiling concentration, because is associated with formaldehyde action mode. Moreover, an environmental method, like Method 1, which allows study formaldehyde concentrations and relates them with activity, provides relevant information for preventive information, since identifies the activity with higher exposure, as well variables that promote exposure. Anatomic pieces represent formaldehyde contamination main source in this occupational setting, and this is of particular interest because all activities are focused on anatomic pieces processing. Since there is no prospect, in short term, for formaldehyde use elimination due to large number of activities that still involve solution use, it can be concluded that exposure to this agent, in this particular occupational setting, is preoccupant, requiring an rapid intervention in order to minimize exposure and prevent potential health effects in exposed workers.
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Resumo: A hiperplasia benigna da prstata (HBP) tem elevada prevalncia nos homens entre os 50 e 79 anos de idade, sendo ubiquitria com o envelhecimento. Devido significativa morbi-mortalidade associada aos tratamentos mdicos e cirrgicos currentemente disponveis, so necessrias novas tecnologias para melhorar os resultados e minimizar o desconforto dos doentes. Recentemente, estudos preliminares de experimentao animal e em 3 doentes tratados, sugeriram a embolizao arterial prosttica selectiva (EAPS) como hiptese teraputica para a HBP. Decidimos investigar se a EAPS poderia ser um procedimento bem sucedido no tratamento da HBP gravemente sintomtica. Para tal realizmos um estudo antomo-radiolgico e clnico em 63 doentes com recurso a uma teraputica inovadora minimamente invasiva guiada pela imagem. Avalimos 126 hemiplvis com recurso a Angio-RM, Angio-TC e Angiografia Digital de Subtraco, com o intuito de definir os padres bsicos de bifurcao das artrias ilacas internas at agora apenas descritos em estudos cadavricos. Estudmos ainda o suprimento vascular arterial prosttico, identificando: 1 as artrias prostticas; 2 origem e direco; 3 os ramos intra-prostticos; 4 anastomoses com outras artrias. Em relao aos resultados anatmicos, identificmos 181 artrias prostticas, j que em 43.7% das hemiplvis existiam dois pedculos arteriais prostticos com origens independentes. A origem mais frequente foi a artria pudenda interna (39.7%), seguida do tronco comum glteo-pudendo (21%) e da artria vesical superior (18.2%). Origens menos frequentes foram a artria obturadora (12.1%), as artrias glteas inferior (3.9%)ou superior (1.7%), ramos rectais provenientes da artria mesentrica inferior (1.7%) e a artria pudenda acessria (1.7%). Identificaram-se anastomoses com as artrias adjacentes em 57.9% dos casos: com a terminao da artria pudenda interna (41.6%),artrias prostticas contra-laterais (18.2%) e homo-laterais (11.7%), com ramos rectais (15.6%) e com artrias vesicais (12.9%). Em relao ao estudo clnico tratmos 63 doentes (idades compreendidas entre 52 - 82 anos, mdia 69.5 anos) com HBP gravemente sintomtica refractria teraputica mdica h mais de 6 meses. Foi possvel avaliao aps o tratamento em 37 doentes: mdia de seguimento de 4.7 meses (variando entre 1 e 12 meses). A EAPS unilateral foi possvel em todos os doentes, com embolizao bilateral em 73% dos casos. A embolizao bilateral no foi possvel em 27% dos casos devido a tortuosidade, alteraes ateroesclerticas e pequeno calibre das artrias ilacas e/ou prostticas. Em mdia houve uma melhoria do International Prostate Symptom Score (IPSS) de 10.8 pontos, da QoL de 1.5 pontos e do Internationl Index of Erectile Function (IIEF) de 2.1 pontos. Houve uma reduo mdia do PSA de 30% (2.4 ng/mL), um aumento do pico de fluxo urinrio (Qmax) de 3.1 - 3.85 mL/s e uma reduo mdia do volume prosttico de 21% (18.5 mL). Registou-se uma complicao major: pequena rea de isqumia da parede vesical tratada cirurgicamente. Em 75% dos doentes tratados obteve-se sucesso clnico com franca melhoria dos sintomas, enquanto 25% dos doentes foram considerados insucesso clnico por se ter registado uma fraca ou ausente melhoria sintomtica aps a embolizao. Os restantes doentes tratados esto sob controlo evolutivo, pararam toda a medicao prosttica, sem qualquer caso de disfuno sexual associada com o tratamento. Este trabalho constitui o primeiro estudo anatmico descritivo in vivo das artrias prostticas, conseguido devido utilizao de tcnicas de imagem nunca usadas para este fim. O uso clnico dos dados anatmicos acima referidos permitiu a implementao de tcnicas de Radiologia de Interveno no tratatamento de uma doena de elevada prevalncia. ------------------------------- ABSTRACT: Benign prostatic hyperplasia (BPH) has high prevalence in men aged 5079 years being ubiquitous with aging. Due to significant morbi-mortality associated with currently available medical and surgical treatments, there is the need for innovative technologies to continue to improve outcomes and minimize patient discomfort and morbidity. Recently, prostatic arterial embolization (PAE) was suggested as a treatmentoption for BPH based on preliminary results from animal studies and 3 treated patients. We decided to investigate if PAE might be a successful treatment option for severely symptomatic BPH patients. We performed a clinical and anatomical-radiological study in 63 patients with the use of an inovative image-guided minimally invasive technique. We evaluated 126 pelvic sides using Angio-MR or Angio-CT and Catheter Angiography before embolisation to treat symptomatic BPH. We aimed to define the main branching patterns of the male internal iliac arteries, so far only studied in the cadaver. We also evaluated the prostatic arterial supply, identifying: 1 the prostatic arteries; 2 origin and direction; 3 intra-prostatic branches; 4 anastomoses with surrounding arteries. Regarding the anatomical study we identified 181 prostatic arteries, because in 43.7% of pelvic sides 2 separate prostatic vascular pedicles were found. The most frequent origin was the internal pudendal artery (39.7%) with the common glutealpudendal trunk (21%) and superior vesical arteries (18.2%) the next commonest. Less frequent origins were the obturator artery (12.1%), the inferior (3.9%) or superior (1.7%) gluteal arteries, rectal branches from the inferior mesenteric artery (1.7%) and the accessory pudendal artery (1.7%). There were anastomoses with the surrounding arteries in 57.9% of cases: termination of the internal pudendal artery (41.6%), contralateral prostatic arteries (18.2%), same-side prostatic arteries (11.7%), rectal branches (15.6%), and vesical arteries (12.9%).Regarding the clinical study, we treated 63 patients aged 5282 years (mean 69.5 years) who presented with symptomatic BPH refractory to medical treatment for at least 6 months. Follow-up evaluation (mean 4.7 months, range 1-12 months) was possible in 37 patients. PAE was achieved in all patients with bilateral embolization in 73%. In 27% PAE was performed unilaterally due to tortuosity, atherosclerotic changes and small size of iliac and prostatic arteries. There was a mean decrease in the IPSS of 10.8 points, a mean improvement in QoL of 1.5 points, and a mean increase in the sexual function score of 2.1 points. There was a mean PSA reduction of 30% (2.4 ng/mL), a Qmax increase of 3.1 to 3.85 mL/sec, and a mean prostate volume decrease of 21% (18.5 mL). There was one major complication: a small area of bladder wall ischemia treated by surgery. Overall, 75% of patients were considered clinical success with major improvement after PAE, while 25% of patients were considered clinical failure with little or no improvement after PAE. All remaining patients are under follow-up, stopped all prostatic medication, and reported no sexual dysfunction. This study is the first one to describe the radiological anatomy of the prostatic arteries, with the use of imaging techniques never used for this purpose before. The clinical use of the anatomical findings allowed the implementation of Interventional Radiology tehniques in the treatment of a disease with a high prevalence.
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INTRODUCTION: Atrial septal defects (ASD) are among the most common congenital anomalies and account for 10% of congenital heart disease in the pediatric age-group and 30% in adults. Closure is indicated when there is evidence of hemodynamic significance or after a paradoxical embolic event. Ten years ago, percutaneous closure became the treatment of choice in our center for all patients with a clear indication and favorable anatomy. In this paper we report the experience of this first decade. OBJECTIVE: To assess the short- and long-term results of our ten-year experience with percutaneous closure of atrial septal defects. METHODS: We studied retrospectively all patients with ASD treated with a percutaneous approach between November 1998 and December 2008. The pediatric age-group consisted of patients younger than 19 years old. Demographic data, clinical indications, minor and major complication rates, success rate and long-term outcome were assessed. RESULTS: In the first ten years of experience 510 patients, of whom 166 were in the pediatric group, were treated in our center by a team of adult and pediatric cardiologists. The overall success rate of the procedure was 98% (97.5% in ASD and 99.5% in patent foramen ovale (PFO). The minor complication rate was 3% (3.4% in ASD and 2% in PFO). The most frequent complication was supraventricular tachycardia. The major complication rate was 1.2% (0.6% in ASD and 2% in PFO). Two patients developed cardiac tamponade due to hemopericardium that was resolved by pericardiocentesis, without need for surgery. One patient had an arterial pseudoaneurysm corrected by vascular surgery. There was no device embolization and no need for urgent surgery in this population. During follow-up two patients had recurrence of ischemic stroke, one had a transient ischemic attack and another had a hemorrhagic stroke. Mortality was 0.6% (0.6% in ASD and 0.5% in PFO). There were no in-hospital deaths. During follow-up there were two deaths, both in the adult group. DISCUSSION AND CONCLUSION: In this population the success rate was high and most of the complications were minor. The results of this collaboration between adult and pediatric cardiologists in the first ten years of activity confirm the safety and efficacy of percutaneous closure of septal defects, when there is careful patient selection and a standardized technique.
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OBJECTIVES: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. METHODS: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. RESULTS: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. CONCLUSIONS: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.
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Although several tendon sources are available for reconstructive surgical procedures, all have one or more shortcomings. The aim of this work was to evaluate if the extensor tendons of the hallux showed anatomical characteristics that could make them an additional source for tendon grafting procedures.The authors performed a detailed morphometric analysis of the extensor tendons of the hallux in 26 lower limbs in order to evaluate the putative association of anatomical variants with hallux valgus, and to attempt to assess the feasibility of using part of the extensor apparatus of the hallux as a source of tendon for grafting procedures.An accessory extensor hallucis longus ten-don was found in 92.3% of cases. The extensor hallucis brevis tendon length was 10.5 0.6 cm; its width was 0.5 0.1 cm, and its thickness varied between 1-2 mm, making it a potentially good candidate as a source of ten-don grafts. Several anatomical variations were observed, namely the fusion of the tendons of the extensor hallucis brevis and the accessory extensor hallucis longus muscles in the distal part of the foot.This new therapeutic option, if implemented, would possibly increase the supply of autogenous donor tissue for reconstructive procedures, thereby enhancing the reconstructive surgeons armamentarium.
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Introduction: Anatomical variations of the extensor tendons to the fingers are of great clinical interest, due to the relatively high frequency of tendon injury in clinical practice. Material and methods: During routine dissection of the right upper limb of a 67-year-old female preserved corpse, the extensor indicis proprius (EIP) muscle belly originated 3 independent tendons, each with a separate fascial sheath, forming a triple EIP tendon. There was a larger tendon, which occupied a central position, that represented the usual single EIP tendon. In addition, there were two thinner radial and ulnar accessory EIP tendons. The radial-EIP tendon crossed deep to the extensor digitorum communis (EDC) tendon to the index finger in the distal half of the dorsum of the hand to reach the radial side of the extensor expansion hood of the index finger. Discussion: According to the literature, the frequency of a triple EIP tendon ranges from 0%, to as high as 7%, although most authors do not acknowledge the presence of this variant in their series. This variant of the EIP tendon, in which the radial-EIP terminated laterally to the termination of the tendon of the EDC to the index finger, may be a source of confusion intraoperatively, as the EIP tendon has traditionally been identified on the basis of its ulnar location with respect to the EDC tendon. Conclusion: The possibility of a triple EIP tendon should certainly be born in mind by all surgeons when performing tendon repairs, tenoplasties or tendon transfers.
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PURPOSE: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries. RESULTS: A total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal-pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression. CONCLUSIONS: PAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.
