Editor's Choice - In Hospital and Long Term Outcomes After Repair of Subclavian and Axillary Artery Injuries.

OBJECTIVE: To evaluate the in hospital and long term outcomes after open or endovascular repair of subclavian and axillary artery injuries. METHODS: This was a retrospective, single centre study. Data were reviewed from patients with subclavian and or axillary injuries who presented to the authors' centre between January 2009 and December 2022. Outcome data included complications, death, amputations, and re-interventions. A p value < .050 was considered to be statistically significant. RESULTS: Over the study period, 62 patients with subclavian or axillary trauma were admitted to the study hospital. Patients were young (median age 32.5 years, range 12 - 53) and most were men (85%); 32 patients experienced blunt trauma, and 30 penetrating trauma. The median injury severity score was 18 (interquartile range [IQR] 9, 34), and 47% of patients had a brachial plexus injury. The arterial injury was occlusion in 62% of patients, and the median ischaemia time was 12.5 hours (IQR 7.13, 24). All patients with subclavian injuries (n = 37) and 13 of 25 patients with an axillary injury underwent endovascular repair (stent graft placement). Open repair was performed in 12 patients with axillary injury (axillobrachial bypass in seven patients). At hospital discharge, the amputation free survival rate was 82% vs. 92% (p = .67), the mortality rate was 10% vs. 8% (p = 1.0), and the amputation rate was 10% vs. 0 (p = .57) for endovascular and open repair, respectively. The mean follow up time was 4.1 ± 3.5 years. After the seven year follow up, the stent primary patency was 42%. No re-interventions or amputations were performed after hospital discharge. Disability was related to fractures and soft tissue and brachial plexus injuries. CONCLUSION: Endovascular treatment was preferred for patients with subclavian artery injuries. Open repair was preferred for patients with penetrating axillary injuries. In hospital and long term complications were related to fractures and soft tissue and brachial plexus injuries, rather than the treatment of arterial injuries. Measures are needed to reduce ischaemia time and improve brachial plexus injury repair.

Persistent hypotension and other complications of celiac plexus neurolysis: A case report and literature review.

Key Clinical Message: Persistent hypotension is a rare complication of celiac plexus neurolysis. It is important to know what are the main and rare complications and how to treat these in patients who undergo CPN. Abstract: Celiac plexus neurolysis is an effective treatment for visceral abdominal pain in oncological patients. Although it rarely has complications, some side effects may occur. A patient with visceral abdominal pain who developed long-lasting orthostatic hypotension and was treated with the use of corticosteroids after a neurolytic celiac plexus block for intractable pain. We describe a rare complication and its treatment and we emphasize the importance of having a guide for the management and treatment of rare complications. We also suggest that every patient be informed about complications, from the most common to the rarest.

Validation of Convolutional Neural Networks for Fast Determination of Whole-Body Metabolic Tumor Burden in Pediatric Lymphoma.

18F-FDG PET/CT quantification of whole-body tumor burden in lymphoma is not routinely performed because of the lack of fast methods. Although the semiautomatic method is fast, it is not fast enough to quantify tumor burden in daily clinical practice. Our purpose was to evaluate the performance of convolutional neural network (CNN) software in localizing neoplastic lesions in whole-body 18F-FDG PET/CT images of pediatric lymphoma patients. Methods: The retrospective image dataset, derived from the data pool of the International Atomic Energy Agency (coordinated research project E12017), included 102 baseline staging 18F-FDG PET/CT studies of pediatric lymphoma patients (mean age, 11 y). The images were quantified to determine the whole-body tumor burden (whole-body metabolic tumor volume [wbMTV] and whole-body total lesion glycolysis [wbTLG]) using semiautomatic software and CNN-based software. Both were displayed as semiautomatic wbMTV and wbTLG and as CNN wbMTV and wbTLG. The intraclass correlation coefficient (ICC) was applied to evaluate concordance between the CNN-based software and the semiautomatic software. Results: Twenty-six patients were excluded from the analysis because the software was unable to perform calculations for them. In the remaining 76 patients, CNN and semiautomatic wbMTV tumor burden metrics correlated strongly (ICC, 0.993; 95% CI, 0.989 - 0.996; P < 0.0001), as did CNN and semiautomatic wbTLG (ICC, 0.999; 95% CI, 0.998-0.999; P < 0.0001). However, the time spent calculating these metrics was significantly (<0.0001) less by CNN (mean, 19 s; range, 11-50 s) than by the semiautomatic method (mean, 21.6 min; range, 3.2-62.1 min), especially in patients with advanced disease. Conclusion: Determining whole-body tumor burden in pediatric lymphoma patients using CNN is fast and feasible in clinical practice.

O acesso aos serviços de saúde pela População em Situação de Rua: uma revisão integrativa / Access to health services by the Homeless Population: an integrative review

RESUMO Objetivamos analisar o acesso da População em Situação de Rua (PSR) à atenção básica, ambulatorial e hospitalar. O estudo foi realizado por meio de uma revisão integrativa (2009 a 2020) com dados retirados da Biblioteca Virtual em Saúde (BVS), nos idiomas português, espanhol e inglês, originados no Brasil e disponíveis em texto completo. Os descritores foram: PSR; morador de rua; acesso aos serviços de saúde; e os termos livres consultório na rua e consultório de rua. Os resultados indicam como barreiras para o acesso à atenção básica os preconceitos e estigmas produzidos sobre a PSR. Na atenção ambulatorial e hospitalar, os artigos revelam que não há acolhimento de pacientes PSR que possuem Transtorno Mental Grave (TMG). A exigência de documentos de identificação para o atendimento, somada à ausência de produção de vínculo e acolhimento, são barreiras presentes da atenção básica à hospitalar. Os estudos indicam o Consultório na Rua e a articulação com as Redes de Assistência Social e Atenção Psicossocial como potencializadores do acesso da PSR aos serviços de saúde. Conclui-se que a PSR requer um processo de trabalho em saúde pautado na equidade como princípio de atuação no Sistema Único de Saúde.

ABSTRACT We aim to analyze the access of the Homeless Population (PSR) to primary, outpatient and hospital care. The study was conducted through an integrative review (2009 to 2020), by Virtual Health Library (VHL), in Portuguese, Spanish and English, originating in Brazil, and available with full text. The descriptors were: PSR; homeless; access to health services; and the free term street office. The results indicate the prejudices and stigmas produced about PSR as barriers to accessing primary care. The results indicate the prejudices and stigmas produced about PSR as barriers to accessing primary care. In outpatient and hospital care, the articles point to the non-acceptance of PSR patients who have Severe Mental Disorder (SMD). The requirement of identification documents for the service, added to the lack of bonding and reception, are barriers present in primary care to hospital care. The studies indicate the Street Office, and the articulation with Social Assistance Networks and psychosocial care as enhancers of PSR's access to health services. It is concluded that the PSR requires a health work process based on equity as a principle of action in the Unified Health System.

Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

Subcutaneous Versus Intravenous Rehydration in Hospitalized Older Adults: A Meta-Analysis.

Subcutaneous rehydration is an optional infusion route in hospitalized older adults. This meta-analysis sought to compare the effectiveness of subcutaneous versus intravenous (IV) fluid administration to reverse mild-to-moderate dehydration in hospitalized older adults. A literature search was performed. No restrictions were imposed regarding language. Three randomized clinical trials conducted with patients 60 years of age or older treated with subcutaneous or IV rehydration were included, with a total sample size of 197 patients. Controlled quasi-randomized and crossover trials were excluded. The primary end point was reversal of dehydration. Secondary end points were patient satisfaction and frequency of adverse events (eg, cellulitis, edema, phlebitis, erythema, hyponatremia, and pain). Both treatments were effective in rehydrating the patients within 48 hours, with no statistically significant difference between the groups. Subcutaneous fluid administration effectively reversed dehydration while protecting against phlebitis. Since the quality of evidence was considerably low, further multicenter randomized clinical trials of efficient methodological quality should be conducted to consolidate the body of evidence.

Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial

Abstract Introduction: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. Objective: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. Methods: A prospective observational study was carried out with 100 children aged 2-10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. Results: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p < 0.000). Conclusion: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Resumo Introdução Delírio ao despertar anestésico é um fenômeno clínico autolimitado muito comum em crianças. Apesar de fisiopatologia ainda incerta, alguns fatores parecem estar envolvidos, como despertar rápido em um ambiente desconhecido, agitação durante a indução anestésica, ansiedade pré-operatória, perturbações ambientais, uso de medicação pré-anestésica, uso de anestésicos inalatórios e dor pós-operatória. Objetivo Determinar a prevalência e os fatores de risco associados ao delírio ao despertar anestésico em crianças submetidas à cirurgia ambulatorial. Métodos Estudo observacional prospectivo, envolveu 100 crianças entre dois e 10 anos, submetidos à cirurgia em caráter ambulatorial. As variáveis de estudo foram: delírio ao despertar anestésico e os fatores de risco associados (ansiedade pré-operatória, comportamento impulsivo da criança, uso de medicação pré-anestésica, indução traumática, tipo de anestesia e dor pós-operatória). Foi feita a regressão multivariada de Poisson para análise das possíveis variáveis explanatórias, na qual foram estimadas as razões de prevalência com os respectivos intervalos de confiança de 95%, considerou-se o nível de significância de 5%. Resultados Delírio e dor foram observados em 27% e 20% das crianças respectivamente. Apenas a dor no pós-operatório, após a regressão de Poisson, mostrou ter uma associação com o delírio ao despertar anestésico, cuja razão de prevalência foi 3,91 (p < 0,000). Conclusão O presente estudo evidenciou uma prevalência de delírio ao despertar anestésico de 27% na população estudada. A incidência de delírio ao despertar anestésico foi maior em crianças que apresentaram dor no pós-operatório.

Difficult laryngoscopy and tracheal intubation: observational study / Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional

Abstract Introduction: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. Method: A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack-Lehane Degrees 3 and 4). Results: In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p = 0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormack-Lehane, which was considered reasonable. On the other hand, a poor agreement (κ = 0.06) was seen between modified Mallampati test and Cormack-Lehane test. Conclusion: The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies.

Resumo Introdução: As complicações anestésicas associadas às vias aéreas difíceis inesperadas por serem potencialmente catastróficas devem ser evitadas. O teste de Mallampati modificado e a manobra de protrusão mandibular possibilitam a identificação da via aérea difícil. O objetivo deste estudo foi associar o teste de Mallampati modificado e a manobra de protrusão mandibular com a laringoscopia (Cormack-Lehane) e tentar identificar um melhor preditor de via aérea difícil na população adulta submetida à cirurgia eletiva. Método: Estudo corte transversal, foram analisados 133 pacientes adultos submetidos a cirurgias eletivas que necessitavam de intubação orotraqueal. Avaliaram-se a acurácia e especificidade do teste de Mallampati modificado e da manobra de protrusão mandibular, correlacionados com laringoscopia difícil (Cormack-Lehane Graus 3 e 4). Resultados: Entre os 133 pacientes avaliados, a taxa de intubação difícil encontrada foi 0,8%, houve associação entre os dois testes preditores propostos (p = 0,012). Foram encontrados os seguintes valores para a especificidade 94,5% e a acurácia 95,4% na manobra de protrusão mandibular. Já para o teste de Mallampati modificado valores de 81,1% e de 81,2% respectivamente. A análise de concordância Kappa identificou entre manobra de protrusão mandibular e Cormarck-Lehane um resultado de 0,240; considerado razoável. Por outro lado, observou-se uma fraca (κ = 0,06) concordância entre o teste de Mallampati modificado e o Cormarck-Lehane. Conclusão: A manobra de protrusão mandibular apresentou acurácia e concordância superiores ao teste de Mallampati modificado, mostrou a capacidade de identificar uma via aérea difícil. Faz-se necessário enfatizar a associação dos testes na avaliação do paciente, destacar a complementariedade deles, minimizar as consequências negativas de laringoscopias repetidas.

[Difficult laryngoscopy and tracheal intubation: observational study]. / Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional.

INTRODUCTION: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. METHOD: A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack-Lehane Degrees 3 and 4). RESULTS: In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p=0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormarck-Lehane, which was considered reasonable. On the other hand, a poor agreement (κ=0.06) was seen between modified Mallampati test and Cormarck-Lehane test. CONCLUSION: The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies.

[Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery]. / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial.

INTRODUCTION: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. OBJECTIVE: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. METHODS: A prospective observational study was carried out with 100 children aged 2 to 10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. RESULTS: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p<0.000). CONCLUSION: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under.

BACKGROUND: Since the introduction of endotracheal intubation in paediatrics, uncuffed endotracheal tubes (ETTs) have been the standard of care for children under eight years old, based on the presumption that complications, particularly postoperative stridor, are higher with cuffed ETTs. The major disadvantages of uncuffed ETTs cited for this shift in procedure include the difficulty in achieving tidal volumes due to leakage around an uncuffed ETT. To seal the airway adequately, uncuffed tubes may need to be exchanged for another tube with a larger diameter, which sometimes requires several attempts before the appropriate size is found. Uncuffed tubes also allow waste anaesthetic gases to escape, contributing significantly to operating room contamination and rendering the anaesthetic procedure more expensive. Our review summarizes the available data, to provide a current perspective on the use of cuffed versus uncuffed endotracheal tubes in children of eight years old or less. OBJECTIVES: To assess the risks and benefits of cuffed versus uncuffed endotracheal tubes during general anaesthesia in children up to eight years old. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS and Google Scholar databases from their inception until March 2017. We also searched databases of ongoing trials, and checked references and citations. We imposed no restriction by language. SELECTION CRITERIA: We included randomized and quasi-randomized controlled trials in which the effects of using cuffed and uncuffed tubes were investigated in children up to eight years old undergoing general anaesthesia. We excluded studies conducted solely in newborn babies. DATA COLLECTION AND ANALYSIS: We applied standard methodological procedures, as defined in the Methodological Expectations of Cochrane Intervention Reviews (MECIR). MAIN RESULTS: We included three trials (2804 children), comparing cuffed with uncuffed ETTs. We rated the risks of bias in all three trials as high. Outcome data were limited. The largest trial was supported by Microcuff GmbH, who provided the cuffed tubes used. The other two trials were small, and should be interpreted with caution. Based on the GRADE approach, we rated the quality of evidence as low to very low.Two trials comparing cuffed versus uncuffed ETTs found no difference between the groups for postextubation stridor (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.65 to 1.33; 2734 children; quality of evidence very low). However, those two trials demonstrated a statistically significantly lower rate of endotracheal tube exchange in the cuffed ETT group (RR 0.07, 95% CI 0.05 to 0.10; 2734 children; quality of evidence very low).One trial with 70 participants found that costs per case were lower in the cuffed ETT group (mean difference (MD) EUR 19.0 lower; 95% CI 24.23 to 13.77 lower; quality of evidence low), since the higher cost of the cuffed tubes may be offset by the savings made with anaesthetic gases.No clear evidence emerged to suggest any difference between cuffed and uncuffed tubes for outcomes such as the need to treat postextubation stridor with tracheal re-intubation (RR 1.85, 95% CI 0.17 to 19.76; 115 children; 2 trials; quality of evidence very low), epinephrine (RR 0.70, 95% CI 0.38 to 1.28; 115 children; 2 trials; quality of evidence very low) or corticosteroid (RR 0.87, 95% CI 0.51 to 1.49; 102 children; 1 trial; quality of evidence very low), or need for intensive care unit (ICU) admission to treat postextubation stridor (RR 2.77, 95% CI 0.30 to 25.78; 102 children; 1 trial; quality of evidence very low).None of the trials included in this review evaluated the ability to deliver appropriate tidal volume. AUTHORS' CONCLUSIONS: Implications for practiceWe are unable to draw definitive conclusions about the comparative effects of cuffed or non-cuffed endotracheal tubes in children undergoing general anaesthesia. Our confidence is limited by risks of bias, imprecision and indirectness. The lower requirement for exchange of tubes with cuffed ETTs was very low-quality evidence, and the requirement for less medical gas used and consequent lower cost was low-quality evidence. In some cases, tracheal re-intubation is required to guarantee an open airway when adequate oxygenation is difficult after removal of the tube, for a variety of reasons including stridor, muscle weakness or obstruction. No data were available to permit evaluation of whether appropriate tidal volumes were delivered. Implications for researchLarge randomized controlled trials of high methodological quality should be conducted to help clarify the risks and benefits of cuffed ETTs for children. Such trials should investigate the capacity to deliver appropriate tidal volume. Future trials should also address cost effectiveness and respiratory complications. Such studies should correlate the age of the child with the duration of intubation, and with possible complications. Studies should also be conducted in newborn babies. Future research should be conducted to compare the effects of the different types or brands of cuffed tubes used worldwide. Finally, trials should be designed to perform more accurate assessments and to diagnose the complications encountered with cuffed compared to uncuffed ETTs.

Função escolar x evasão: a falência da educação para o trabalho / School Function and pupils' drop-out: The failure of education for work

O artigo apresenta a discussão de uma pesquisa realizada numa escola da rede pública de Fortaleza-CE, como parte de uma disciplina de Psicologia Escolar. A pesquisa investigou as relações entre a função da escola e evasão escolar, pelo ponto de vista de educadores e alunos. Foi utilizado o referencial teórico foucaultiano para a análise dos dados. Como resultados, podemos apontar que há um desencontro entre a função que a escola deveria assumir na ótica dos alunos e a função que os educadores a fazem assumir ao se comprometerem com determinadas obrigações institucionais, resultando disso a massiva evasão encontrada no estabelecimento em questão. Compreendemos que o fato de a escola pública não assegurar uma vaga no mercado de trabalho especializado para seus alunos, via vestibular ou ensino técnico, contrapõe-se à função escolar de educação para o trabalho. Estando enfraquecida nessa função, a escola não consegue manter seus alunos, mesmo apelando para os mais diversos mecanismos de controle disciplinares.

The article discusses the results of a research done in a public school in Fortaleza (Brazil) as part of a School Psychology course. The research investigated the relationship between the function of school and pupils' drop-out based upon the opinions of the pupils and teachers. It was used a Foucauldian theoretical reference in order to analyze the collected data. It could be found that there is a difference between the school function perceived by the pupils and the function that teachers try to develop through institutional rules, resulting on the massive student drop-out reported in the researched school. When public schools fail to assure a better place for its pupils in the job market, through university access or technical formation, the idea of school as 'education for work' becomes contradictory. When this function is undermined, the school cannot avoid student drop-out despite the use of different disciplinary control mechanisms.

Estado atual das restauraçöes com amálgama adesivo / Conditions actual of bonded amalgam restorations

Revisäo da literatura a respeito da técnica de restauraçöes com amálgama adesivo, comparando esta técnica com a convencional. Os autores concluíram que esta técnica apresenta algumas vantagens, oferecendo maior força de adesäo entre o amálgama e o esmalte, e apresentando maior preservaçäo da estrutura do dente, e diminuindo a infiltraçäo entre o amálgama e a estrutura dentária