Partial lesions of the intratemporal segment of the facial nerve: graft versus partial reconstruction.

OBJECTIVES: In cases of partial lesions of the intratemporal segment of the facial nerve, should the surgeon perform an intraoperative partial reconstruction, or partially remove the injured segment and place a graft? We present results from partial lesion reconstruction on the intratemporal segment of the facial nerve. METHODS: A retrospective study on 42 patients who presented partial lesions on the intratemporal segment of the facial nerve was performed between 1988 and 2005. The patients were divided into 3 groups based on the procedure used: interposition of the partial graft on the injured area of the nerve (group 1; 12 patients); keeping the preserved part and performing tubulization (group 2; 8 patients); and dividing the parts of the injured nerve (proximal and distal) and placing a total graft of the sural nerve (group 3; 22 patients). RESULTS: Fracture of the temporal bone was the most frequent cause of the lesion in all groups, followed by iatrogenic causes (p < 0.005). Those who obtained results lower than or equal to III on the House-Brackmann scale were 1 (8.3%) of the patients in group 1, none (0.0%) of the patients in group 2, and 15 (68.2%) of the patients in group 3 (p <0.001). CONCLUSIONS: The best surgical technique for therapy of a partial lesion of the facial nerve is still questionable. Among these 42 patients, the best results were those from the total graft of the facial nerve.

Hypertension in employees of a University General Hospital.

PURPOSE: To find out the prevalence of hypertension in employees of the Hospital and relate it to social demographic variables. METHODS: Blood pressure measurement was performed with a mercury sphygmomanometer, using an appropriate cuff size for arm circumference, weight, and height in a population sample of 864 individuals out of the 9,905 employees of a University General Hospital stratified by gender, age, and job position. RESULTS: Hypertension prevalence was 26% (62% of these reported being aware of their hypertension and 38% were unaware but had systolic/diastolic blood pressures of >140 and/or >90 mm Hg at the moment of the measurement). Of those who were aware of having hypertension, 51% were found to be hypertensive at the moment of the measurement. The prevalence was found to be 17%, 23%, and 29% (P <.05) in physicians, nursing staff, and "others", respectively. The univariate analysis showed a significant odds ratio for the male gender, age >50 years, work unit being the Institute of Radiology and the Administration Building, educational level 10 years, and body mass index >30 kg/m2. The multivariate logistic regression model revealed a statistically significant association of hypertension with the following variables: gender, age, skin color, family income, and body mass index. CONCLUSIONS: Hypertension prevalence was high, mainly in those who were not physicians or members of the nursing staff. High-risk groups (obese, non-white, men, low family income) should be better advised of prevention and early diagnosis of hypertension by means of special programs.

O uso de cola de fibrina humana na anastomose de lesões traumáticas parciais do nervo facial / The use of human fibrin glue in the anastomosis of partial traumatic injuries of the facial nerve

Introdução: O uso de cola de fibrina humana na anastomose do nervo facial tem se mostrado uma opção bastante segura e rápida para os cirurgiões. Objetivo: Avaliar o uso da cola de fibrina humana na realização de anastomose do nervo facial em uma série de 42 pacientes que sofreram lesão parcial do nervo facial no segmento intratemporal e foram tratados por três diferentes técnicas de anastomose. Método: Estudo retrospectivo de 42 pacientes apresentavam lesão parcial no segmento intratemporal do nervo facial o qual as anastomoses foram fixadas com cola de fibrina humana. Dividiu-os em 3 grupos: interposição de enxerto parcial na parte lesada do nervo(Grupo 1=12 pacientes); manter a parte preservada e realizar tubolização (Grupo 2= 8 pacientes); seccionar as partes do nervo lesionado (proximal e distal) e interpor enxerto total de nervo sural(Grupo3 =22 pacientes). Resultados: Pacientes com resultado menor ou igual a III na escala House-Brackmann somaram 8,3% (1) no grupo 1, 0,0% (0) no grupo 2 e 68.2% (15) no grupo 3 (p<0.001). Discussão: Ainda existe controvérsia quanto a melhor técnica cirúrgica no tratamento da lesão parcial do nervo facial. O uso da cola de fibrina tem mostrado resultados semelhantes a sutura com pontos. Conclusões: O uso de cola de fibrina humana mostrou ser eficaz na realização destes três tipos diferentes de anastomose do nervo facial sendo que nesta série de 42 pacientes, os indivíduos do grupo 3 (enxerto total) tiveram melhores resultados estatisticamente comprovados se compararmos aos dos grupos 1 (reconstrução parcial) e 2 (tubolização).

Introduction: The use of human fibrin glue in anastomosis of the facial nerve have been an option rather safe and quick for surgeons. Objective: To evaluate the use of the glue of human fibrin glue in the anastomosis of the facial nerve in a series of 42 patients who had suffered partial injury from the facial nerve in the intratemporal segment and they had been treated by three different techniques of anastomosis. Method: A retrospective study on 42 patients who presented partial lesion on intratemporal segment of facial nerve. Patients were divided into three groups: interposition of partial graft on the injured area of the nerve (group 1 - 12 patients); to keep the preserved part and perform tubulization (group 2 - 8 patients); to divide parts of injured nerve (proximal and distal) and place total graft of sural nerve (group 3 - 22 patients). Results: Results lower or equal III on House-Brackmann scale were: 1 (8.3%) patient on group 1; 0 (0.0%) patient on group 2 and 15 (68.2%) of patients on group 3 (p>0.001). Discussion: The best surgery technique for partial lesion therapy of facial nerve is still questionable. The use of the fibrin glue has shown resulted similar to the suture with points. Conclusion: The use The use of human fibrin glue showed to be efficient in the accomplishment of these three different anastomosis types of the facial nerve. Among these 42 patients, the best achieved results were from total graft of facial nerve when comparing to others.

Protocolo médico e audiológico para seleção e avaliação dos candidatos à prótese auditiva implantável / Medical and audiological protocol for selection and evaluation for vibrant soundbridge surgically implantable middle ear device

Atualmente, indivíduos com perda auditiva de grau moderado a severo, do tipo sensório-neural, mista ou condutiva podem se beneficiar de diferentes tipos de próteses auditivas externas ou cirurgicamente implantáveis para sua reabilitação...

Currently, individuals with moderate to severe hearing loss, sensorioneural type, mixed or conductive can benefit from different types of hearing devices, external or surgically implantable to their rehabilitation...

Lesões parciais no segmento intratemporal do nervo facial: enxerto total ou reconstrução parcial? / Partial lesions of the intratemporal segment of the facial nerve graft or partial reconstruction?

Traumas na região de cabeça e pescoço podem produzir lesões parciais no segmento intratemporal do nervo facial. Quando isto ocorre, o cirurgião deve optar no intra-operatório pela reconstrução parcial ou eliminar o segmento parcialmente lesado e interpor um enxerto?...

In cases of partial lesions on intratemporal segment of facial nerve, should surgeon chose intraoperative way for partial reconstruction or partially remove injured segment of facial nerve...

Hypertension in employees of a University General Hospital

OBJETIVO: Conhecer a prevalência de hipertensão arterial em funcionários de um complexo hospitalar e relacionar com variáveis sócio demográficas. MÉTODOS: Foi medida a pressão arterial com aparelho de coluna de mercúrio e manguito adequado à circunferência do braço, o peso e a altura em amostra de 864 dos 9.905 funcionários do Hospital Universitário estratificada de acordo com sexo, idade e ocupação. RESULTADOS: A prevalência de hipertensão foi de 26% (hipertensão referida = 62% ou pressão sistólica > 140 e/ou > 90 mm Hg no momento da medida = 38%). Dos que referiram 51% estavam hipertensos no momento da medida. A prevalência foi 17, 23 e 29% (p < 0,05) nos médicos, enfermagem e "outros". Análise univariada mostrou "odds ratio" significante para o sexo masculino, idade > 50 anos, unidade de trabalho para o Instituto de Radiologia e Prédio da Administração, escolaridade 10 anos e índice de massa corporal (IMC) maior ou igual a 30 kg/m2. O modelo de regressão logística com procedimento "stepwise" mostrou associação estatisticamente significante com hipertensão arterial para as variáveis: sexo, idade, cor da pele, renda familiar e IMC. CONCLUSÃO: A prevalência de hipertensão foi alta em funcionários do Complexo Hospital das Clínicas, principalmente nos de ocupação diferente de médico e enfermagem. Os grupos de maior risco (homens, cor preta, baixa renda familiar, obesos) precisam ser orientados quanto a prevenção e diagnóstico precoce da doença através de programas especiais.