Everything old is new again. revisiting hypophysectomy for the treatment of refractory cancer-related pain: a systematic review.

Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.

Biological activity of cinnamaldehyde, citronellal, geraniol and anacardic acid on Haemonchus contortus isolates susceptible and resistant to synthetic anthelmintics.

Parasitism by gastrointestinal nematodes is a challenge for small ruminant farming worldwide. It causes productive and economic losses, especially due to parasite resistance to conventional anthelmintics. Natural compounds with antiparasitic activity are a potential alternative for controlling these parasites especially when considering the widespread occurrence of anthelmintic resistance. Our objective was to evaluate the activity of anacardic acid, geraniol, cinnamaldehyde and citronellal on Haemonchus contortus isolates with different levels of anthelmintic resistance profiles. These compounds were tested using egg hatch assays (EHAs), larval development tests (LDTs) as well as LDTs on mini-fecal cultures, on the Haemonchus contortus isolates Kokstad (KOK-resistant to all anthelmintics), Inbred-Strain-Edinburgh (ISE-susceptible to all anthelmintics) and Echevarria (ECH-susceptible to all anthelmintics). Effective concentrations to inhibit 50% (EC50) and 95% (EC95) of egg hatching and larval development were calculated. Results for EHA and LDT for all tested compounds, considering EC50 and EC95 values, showed low variation among the studied isolates with most RF values below 2x. All studied compounds showed efficacy against egg hatching and larval development of H. contortus isolates regardless of anthelmintic resistance profiles. The compounds with the smallest EC50 and EC95 values were cinnamaldehyde and anacardic acid making them promising candidates for future in vivo studies.

Giant anterior sacral meningocele associated with hydroureteronephrosis and renal injury: illustrative case.

BACKGROUND: Anterior sacral meningocele (ASM) is a defect in the closure of the neural tube. Patients can be asymptomatic or present with genitourinary, neurological, reproductive, or colorectal dysfunction. Magnetic resonance imaging (MRI) is the gold standard test because it can assess communication between the spinal subarachnoid space and the lesion and identify other abnormalities. Surgical correction is the definitive treatment because untreated cases have a mortality rate of more than 30%. OBSERVATIONS: A 24-year-old woman with Marfan syndrome presented with polyuria, recurrent urinary tract infections, and renal injury for 3 months along with a globose abdomen, with a palpable mass in the middle and lower third of the abdomen that was massive on percussion. MRI showed an ASM consisting of two cystic lesions measuring 15.4 × 14.3 × 15.8 and 6.7 × 6.1 × 5.9 cm, respectively, compressing the distal third of the right ureter and causing a hydroureteronephrosis. Drainage and ligature of the cystic lesion were performed. The urinary outcome was excellent, with full recovery after surgery. LESSONS: ASM should be suspected in all abdominal masses with progressive symptoms in the setting of Marfan syndrome. Computed tomography and MRI are important to investigate genitourinary anomalies or other types of dysraphism to guide the best surgical approach.

E.L., a modern-day Phineas Gage: Revisiting frontal lobe injury.

Background: How the prefrontal cortex (PFC) recovers its functionality following lesions remains a conundrum. Recent work has uncovered the importance of transient low-frequency oscillatory activity (LFO; < 4 Hz) for the recovery of an injured brain. We aimed to determine whether persistent cortical oscillatory dynamics contribute to brain capability to support 'normal life' following injury. Methods: In this 9-year prospective longitudinal study (08/2012-2021), we collected data from the patient E.L., a modern-day Phineas Gage, who suffered from lesions, impacting 11% of his total brain mass, to his right PFC and supplementary motor area after his skull was transfixed by an iron rod. A systematic evaluation of clinical, electrophysiologic, brain imaging, neuropsychological and behavioural testing were used to clarify the clinical significance of relationship between LFO discharge and executive dysfunctions and compare E.L.´s disorders to that attributed to Gage (1848), a landmark in the history of neurology and neuroscience. Findings: Selective recruitment of the non-injured left hemisphere during execution of unimanual right-hand movements resulted in the emergence of robust LFO, an EEG-detected marker for disconnection of brain areas, in the damaged right hemisphere. In contrast, recruitment of the damaged right hemisphere during contralateral hand movement, resulted in the co-activation of the left hemisphere and decreased right hemisphere LFO to levels of controls enabling performance, suggesting a target for neuromodulation. Similarly, transcranial magnetic stimulation (TMS), used to create a temporary virtual-lesion over E.L.'s healthy hemisphere, disrupted the modulation of contralateral LFO, disturbing behaviour and impairing executive function tasks. In contrast to Gage, reasoning, planning, working memory, social, sexual and family behaviours eluded clinical inspection by decreasing LFO in the delta frequency range during motor and executive functioning. Interpretation: Our study suggests that modulation of LFO dynamics is an important mechanism by which PFC accommodates neurological injuries, supporting the reports of Gage´s recovery, and represents an attractive target for therapeutic interventions. Funding: Fundação de Amparo Pesquisa Rio de Janeiro (FAPERJ), Universidade Federal do Rio de Janeiro (intramural), and Fiocruz/Ministery of Health (INOVA Fiocruz).

Complicated Cerebral Venous Thrombosis During the First Trimester of Pregnancy.

Pregnancy and puerperium are known conditions associated with venous thrombotic events, which may present atypically in cases such as cerebral venous thrombosis. Since these are uncommon events, there is a paucity of reports and protocols for the management of these patients, resulting in no clear consensus in the literature. We report a case of a woman, nine weeks pregnant, who developed thrombosis of the right transverse and superior sagittal sinuses. Our diagnosis was made with computed tomography angiography, and due to a significant midline shift, an emergency decompressive hemicraniectomy was required. Although medical and surgical therapies for intracranial hypertension and anticoagulation were optimized in accordance with current medical literature, the patient suffered a spontaneous abortion and remained with significant neurological sequelae.

Method development for the determination of Synthetic Musks and Organophosphorus Pesticides in Human Adipose Tissue.

Synthetic musks and organophosphorus pesticides represent a potential risk to the human health since exposure can lead to distinct types of carcinogenesis and endocrine disorders. These are lipophilic compounds as such, prone to deposit and persist in fat tissues, mainly in adipose tissue. Very few studies have reported on the occurrence and accumulation profile of these contaminants in human adipose tissue. Analytical methods for the detection and quantification of synthetic musks and organophosphorus pesticides in adipose tissue are lacking. In this study, the efficacy of different extraction with ultrasonic homogenizer and dispersive solid-phase extraction (d-SPE) clean-up methods were evaluated in human adipose tissue. The relative sample clean-up was assessed by measurement of total lipid content. The quantification of four synthetic musks and six organophosphorus pesticides were performed by gas chromatography (GC) mass spectrometry (MS) and flame photometric detection (FPD), respectively. The d-SPE clean-up with 50 mg PSA, 150 mg MgSO4, 100 mg C18EC and 50 mg Z-Sep provided the most effective clean-up, removing the greatest amount of interfering substances including lipids and simultaneously ensuring good chromatographic separation and recoveries. Method detection limits were between 4 to 9 ng/g for synthetic musk and 1 to 7 ng/g for organophosphorus pesticides in adipose tissue. The proposed method was applied to adipose tissue of obese patients and positive samples were confirmed with GC tandem mass spectrometry. Galaxolide was found in all the samples tested with concentrations ranging from 0.08 to 0.5 µg/g of adipose tissue. No other synthetic musk studied was detected. Organophosphorus pesticides were not found in the analysed samples. The developed analytical procedures were successful and can easily be applied to biomonitoring these compounds in human adipose tissue.

Nematocidal Effect of Oyster Culinary-Medicinal Mushroom Pleurotus ostreatus (Agaricomycetes) against Haemonchus contortus.

The nematocidal effect of Pleurotus ostreatus (white variety of oyster mushroom) aqueous extract (AE) was evaluated against Haemonchus contortus eggs and infective larvae (L3) in vitro and in artificially infected gerbils (Meriones unguiculatus). The chemical analyses indicated that constituents of AE are tridecanoic, tetradecanoic, linolelaidic, 9,15-octadecadienoic, and oxalic acids. P. ostreatus extract inhibited larval hatching by 100% at the concentration of 2.24 mg/mL and (50% effective concentration) EC50 of 0.73 mg/mL. In the larval development test, AE induced a larvicidal effect at the concentration of 50 mg/mL and EC50 of 17.24 mg/mL. The larval migration test revealed a reduction of 94.7% at a concentration of as low as 4 mg/mL and EC50 of 1.25 mg/mL. No significant effects of treatment with P. ostreatus AE were seen on H. contortus in the gerbil model. Thus, our results demonstrate an important nematocidal in vitro effect of P. ostreatus AE against the parasite H. contortus. However, further investigations are necessary to confirm the anthelmintic potential of P. ostreatus extract in small ruminants.

Elaboração de uma metodologia baseada em estatística para encaminhamento dos casos da COVID-19 / Elaboración de una metodología basada en estadísticas para la derivación a tratamiento de casos de COVID-19 / Statistical method to determine the need for hospitalization of COVID-19 patients

Resumo A taxa de crescimento da COVID-19 é preocupante em todo o mundo. O desenvolvimento de métodos indiretos para direcionar as internações hospitalares somente para os casos necessários é de fundamental importância para impedir superlotação do sistema de saúde. O objetivo geral deste artigo é propor uma metodologia estatística, baseada na regressão logística, capaz de indicar se um paciente que testou positivo para COVID-19 deve ser direcionado ao isolamento domiciliar ou ficar internado no hospital com base em exames básicos de sangue e na idade. Os dados partiram de 5.645 testes de sangue de pacientes no período de março e abril de 2020. Com a utilização das variáveis independentes proteína C-reativa, neutrophils, monocytes e idade do paciente acometido pela COVID-19, pode-se prever com razoável grau de precisão se, ao chegar ao hospital e testar positivo, o indivíduo deve ser recomendado a ficar recolhido em sua residência ou se deve ser internado numa unidade de saúde.

Resumen La tasa de crecimiento de la COVID-19 es preocupante en todo el mundo. El desarrollo de métodos indirectos para orientar las internaciones hospitalarias solo en los casos necesarios es de fundamental importancia para prevenir el hacinamiento en el sistema de salud. El objetivo general de este artículo es proponer una metodología estadística, basada en regresión logística, capaz de indicar si un paciente que dio positivo para COVID-19 debe permanecer en aislamiento domiciliario o internado en un hospital según los análisis de sangre y la edad. Los datos se tomaron de 5.645 análisis de sangre de pacientes en el período de marzo a abril de 2020. Utilizando las variables independientes proteína C reactiva, neutrófilos, monocitos y edad del paciente afectado por COVID-19, se puede determinar, con un grado razonable de precisión, si al llegar al hospital y tener resultado positivo, se debe recomendar que el individuo permanezca en su residencia o sea internado en una unidad de salud.

Abstract The growth rate of COVID-19 is causing worldwide concern. The development of indirect methods used to determine hospitalizations only for necessary cases is of fundamental importance to prevent overcrowding in the health system. The general objective of this article is to propose a statistical method, based on logistic regression, capable of indicating whether a patient who tests positive for COVID-19 should be directed to home isolation or be admitted to a hospital, based on blood tests and age. The data was collected from 5,645 blood tests of patients in March and April 2020. Based on the use of the independent variables 'C-reactive protein,' 'neutrophils,' and 'monocytes,' as well as the age of the patient affected by COVID-19, it is possible to predict with a reasonable degree of accuracy whether, upon arriving at the hospital and testing positive, the individual should be recommended to isolate at home or be admitted to a healthcare facility.

Jejunal stromal tumor and neurofibromatosis / Tumor estromal de jejuno e neurofibromatose

Abstract Gastrointestinal stromal tumors, although rare, are the most common primary mesenchymal neoplasms of the gastrointestinal tract and originate from the interstitial cells of Cajal. They present slow growth and symptoms such as bleeding, abdominal pain or discomfort, and the presence of an abdominal mass. The most affected organs are the stomach and small intestine. Differential diagnoses for gastrointestinal stromal tumor include adenocarcinoma and small intestine lymphoma, metastasis, and carcinoid tumor. Gastrointestinal stromal tumors have been associated with familial syndromes such as type 1 neurofibromatosis, considered a predisposing factor for tumors in the small intestine. This study aimed to report a case of gastrointestinal stromal tumor in the jejunal region in a patient with type 1 neurofibromatosis, followed-up for two years, who underwent laparoscopic segmental enterectomy and diagnosis determined by histopathology and immunohistochemistry. The diagnosis of small intestine gastrointestinal stromal tumor is challenging because of its low incidence, nonspecific symptoms, relative inaccessibility of the small intestine to conventional endoscopic examination, broad spectrum of radiological appearances, and the fact that the nature of the mass is difficult to determine with imaging examinations of the abdomen alone. Thus, the small intestine gastrointestinal stromal tumor may be erroneously diagnosed as pancreatic, gynecological, or mesenteric tumors. The literature does not present many reports on the association of jejunal gastrointestinal stromal tumor with neurofibromatosis. Understanding the tumoral behavior of small intestine gastrointestinal stromal tumor in this subgroup of patients would allow better follow-up.

Resumo Os tumores estromais gastrointestinais, embora raros, são as neoplasias mesenquimais primárias mais comuns do trato gastrointestinal e originam-se das células intersticiais de Cajal. Apresentam crescimento lento e manifestam sintomas como sangramento, dor ou desconforto abdominal e presença de massa abdominal. Os órgãos mais acometidos são estômago e intestino delgado. Os diagnósticos diferenciais para tumores estromais gastrointestinais incluem adenocarcinoma e linfoma de intestino delgado, metástases e tumor carcinoide. Os tumores estromais gastrointestinais têm sido associados a síndromes familiares como a neurofibromatose tipo 1, considerada um fator predisponente para tumores no intestino delgado. O objetivo desse trabalho é relatar um caso de tumor estromal gastrointestinal em região jejunal em paciente portadora de neurofibromatose tipo 1, com 2 anos de seguimento, submetida a enterectomia segmentar laparoscópica e diagnóstico determinados pela histopatologia e imuno-histoquímica. O diagnóstico de tumor estromal gastrointestinal do intestino delgado é desafiador, devido a sua baixa incidência, sintomas inespecíficos, relativa inacessibilidade do intestino delgado ao exame endoscópico convencional, amplo espectro de aparências radiológicas e difícil determinação da natureza da massa apenas com exames de imagens do abdome. Assim, tumor estromal gastrointestinal no intestino delgado podem ser erroneamente diagnosticados como tumores pancreáticos, tumores ginecológicos, ou tumores do mesentério. A descrição científica da associação de tumor estromal gastrointestinal de jejuno com neurofibromatose é incomum. Tais descrições permitem melhor seguimento dos pacientes a partir do momento que se entende o comportamento tumoral do tumor estromal gastrointestinal de intestino delgado nesse subgrupo de pacientes.

Prevalence of chronic pain in Brazil: a descriptive study / Prevalência de dor crônica no Brasil: estudo descritivo

ABSTRACT BACKGROUND AND OBJECTIVES: Very little is known about the epidemiology of chronic pain in Brazil; especially in the case of multiple pain prevalence surveys. Knowing about the prevalence of chronic pain in the Brazilian population is an important step in revealing the scope and magnitude of its effects, providing a guide to preventive and intervention strategies, mainly public policies. The objective is to review descriptively the publications made in Brazil to estimate the prevalence of chronic pain in the Brazilian population. CONTENTS: The search in the indexed database of the Portal of Periodicals of CAPES with the Descriptors in Health Sciences: "Prevalence" and "Chronic Pain" returned, after the screening, a total of 10 articles. The prevalence of chronic pain varied from 29.3 to 73.3%, affecting more women than men and the most prevalent site was the dorsal/lumbar region. Most of the studies showed percentage higher than the estimated for the world population. However, we cannot say that the prevalence of chronic pain in the Brazilian population is higher since the values of the surveys reflect only regional data. CONCLUSION: The studies found in this review showed a recent interest in the epidemiology of chronic pain in the country, all in the last decade. However, they do not allow an accurate estimate, and more studies are needed to obtain a representative prevalence of the Brazilian population.

RESUMO JUSTIFICATIVA E OBJETIVOS: Muito pouco se conhece sobre a epidemiologia da dor crônica no Brasil; principalmente, tratando-se de pesquisas de prevalência de dores múltiplas. Conhecer sobre a prevalência da dor crônica na população brasileira é um passo importante no sentido de revelar a abrangência e magnitude de seus efeitos, proporcionando um direcionamento para as estratégias preventivas e de intervenção, principalmente políticas públicas. O objetivo deste estudo foi revisar descritivamente as publicações realizadas no Brasil para estimar a prevalência de dor crônica na população brasileira. CONTEÚDO: A busca se deu na base de dados indexadas do Portal de Periódicos da CAPES com os Descritores em Ciências da Saúde: "Prevalência¼ e «Dor crônica¼ retornou, após a triagem, um total de 10 artigos. A prevalência de dor crônica dos trabalhos variou de 29,3 a 73,3%, tendo afetado mais mulheres que homens e o local mais prevalente foi a região dorsal/lombar. A grande parte dos estudos encontrou uma percentagem maior que a estimada na população mundial, no entanto não se pode afirmar que a prevalência de dor crônica da população brasileira seja de fato maior, uma vez que os valores das pesquisas refletem apenas dados regionais. CONCLUSÃO: Os estudos encontrados demonstraram um recente interesse sobre a epidemiologia da dor crônica no país, todos da última década; porém, não permitem uma estimativa precisa, sendo necessário mais estudos para se obter uma prevalência representativa da população do Brasil.

Atuação do Ministério do Trabalho na fiscalização das condições de segurança e saúde dos trabalhadores, Brasil, 1996-2012 / Brazilian Ministry of Labor's inspection on workers' safety and health, Brazil, 1996-2012

Objetivos: o estudo avalia a atuação do Ministério do Trabalho do Brasil no período 1996-2012, na área de segurança e saúde no trabalho (SST), com ênfase nas ações desenvolvidas em 2011. Métodos: analisa documentos e dados registrados no Sistema Federal de Inspeção do Trabalho relacionados à fiscalização das normas de SST pelos auditores fiscais do trabalho, especialmente as que exigem maior presença no ambiente laboral. Compara áreas de atuação com indicadores relacionados à incapacidade por acidentes e mortalidade no trabalho. Resultados: estimou-se que as ações em SST são executadas por 785 auditores (25,1% do quadro). Identificaram-se mudanças no perfil das ações de SST, com aumentos das sanções e dos embargos e interdições em razão de risco grave e iminente à saúde e à vida. As ações são, geralmente, pouco abrangentes e não se destinam aos setores com maiores taxas de mortalidade e invalidez resultantes de acidentes do trabalho. Conclusões: o modelo atual dilui excessivamente ações de SST dentro do conjunto das ações de inspeção do trabalho. Não prioriza a fiscalização em áreas que apresentam piores indicadores de morbimortalidade ocupacional e mantém um quadro insuficiente de auditores dedicados prioritariamente à SST. A atuação dos inspetores ocorre sem estrutura material e orçamentária adequadas e, por vezes, sem a formação técnica necessária. .

Background: even with high rates of death and disability, occupational injuries and diseases are "neglected health problems" in Brazil. Objective: to study the Brazilian Ministry of Labor's performance concerning occupational safety and health (OSH) in the period 1996-2012, with emphasis to 2011. Methods: documents produced by the Federal System for Labor Inspection related to the labor inspections of OSH standards were analyzed, especially those requiring detailed inspections and longer presence at worksites. The study also compares targeted areas of inspection with higher work-related disability and mortality indicators. Results: OSH actions were taken by 785 inspectors (25,1% of the staff). We have identified changes in the OSH inspection profiles with increased number of penalties due to serious and eminent health and life risks. It was found that inspections were not inclusive enough and did not address sectors presenting the highest mortality and disability rates as result of occupational injuries. Conclusion: the present institutional model exceedingly attenuates OHS acting in labor inspection procedures. It does not take into account areas that show the worst occupational morbimortality indicators and keeps a very small staff of auditors fully dedicated to OSH. These inspectors work in a limited material and budgetary infrastructure, and, not rarely, lack proper technical training. .

Bariatric surgery: is admission to the intensive care unit necessary? / Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva?

OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was used for release from the post-anesthesia recovery room and to define where the patient should be routinely referred for postoperative. RESULTS: Among the 120 patients, 83 were women and 37 men with a mean age ranging from 35.4 ± 10.5 years (18 to 66 years), body mass index 45.6 ± 10.5. The time between hospital admission and start of surgery was 140.7 ± 81.8 minutes, surgery time was 105 ± 28.6 minutes, time of post-anesthesia recovery room was between 125 ± 38 minutes and length of hospital stay was 47.7 ± 12.4 hours, with 100% of the patients walking in 24 hours. The Aldrete and Kroulik index in the post-anesthesia recovery room achieved scores of 10 to 120 minutes in all patients, with a 100% survival . CONCLUSION: Using the Aldrete and Kroulik index in the post-anesthesia of gastric bypass by video laparoscopy in primary bariatric surgery, no patient was admitted in intensive care unit and no major complication was observed.

Morfologia de potros da raça Brasileiro de Hipismo / Morphology of Brasileiro de Hipismo foals

Objetivou-se avaliar a morfologia de potros da raça Brasileiro de Hipismo, utilizando análise de imagens digitais e medidas de perímetros corporais para estimativa de índices corporais dos animais. As mensurações lineares e angulares foram obtidas utilizando imagens digitais dos potros com câmera acionada pelo aplicativo Simi Reality Motion Systems®. As medidas foram baseadas em pontos anatômicos realçados com 19 marcadores reflexivos. A análise estatística descritiva dos resultados foi realizada utilizando o programa SAS. Os potros estavam em crescimento, com aumento das medidas lineares de altura na cernelha e na garupa, comprimento do corpo, distância escápulo-metacarpofalângica e nos comprimentos do pescoço, da perna e do antebraço. Os ângulos úmero-radial, metacarpo-falângico, fêmoro-tibial, tíbio-metatarsico aumentaram com a idade, enquanto que os ângulos da cabeça, do pescoço, coxo-femoral, metatarso-falângico, escápulo-solo e coxo-solo foram variáveis entre os momentos de avaliação. Os potros foram classificados em mediolíneos e hipermétricos pelos índices Corporal e Dáctilo-torácico, respectivamente. A avaliação do crescimento dos potros foi possível através da imagem digital.

This research aimed to evaluate the morphology of Brasileiro de Hipismo foals using digital image analysis and girth measurements to estimate body indexes of animals. The linear and angular measurements were obtained by digital images of the foals with camera triggered by Simi Reality Motion Systems®. The measures were based on anatomical landmarks highlighted with 19 reflective markers. A descriptive statistical analysis of the results was performed using the SAS program. The foals were growing, with increased linear measurements of height at withers and croup, body length, distance from shoulder-fetlock and neck length, leg length and forearm length. The angles humerus-radial, metacarpal-falangeano, femoro-tibial, tibio-metatarsal increased with age, whiles the angles of the head, neck, coxofemoral, metatarsal-falangeano, shoulder-floor and coxae-floor were variable among the periods. The foals were classified as medium shape and hypermetric by Corporal Index, Dactilo-thoracic Index, respectively. Assessment of growth of the foals was possible through a digital image.

O trabalhador com deficiência e as práticas de inclusão no mercado de trabalho de Salvador, Bahia / Workers with disability and process for their inclusion in the labor market in Salvador, Bahia, Brazil

O autor analisou políticas e práticas de inclusão da pessoa com deficiência física no mercado de trabalho em Salvador, Bahia. Considera que a deficiência é, acima de tudo, um produto social, e que as estratégias de inclusão no trabalho adotadas no Brasil são insuficientes, não levando em conta aspectos relevantes do complexo mundo do trabalho e dos sujeitos envolvidos. Foram realizadas, em 2003, entrevistas semiestruturadas com 22 deficientes físicos, 6 chefes e colegas desses trabalhadores com deficiência, assim como 7 técnicos e dirigentes de instituições relacionadas à deficiência, totalizando 35 entrevistas. Foram feitas revisão de documentos e estatísticas e visitas a instituições. O autor constatou que o sistema de cotas de emprego tem se destacado principalmente pela discussão que traz sobre o tema do direito ao trabalho das pessoas com deficiência. Identificou que as estratégias e práticas de inclusão estão marcadas por situações que denomina de ironias da desigualdade, como, por exemplo, a ameaça de chefes a empregados, obrigando-os a tratar os deficientes como normais, a visão da deficiência como virtude, por facilitar o acesso ao emprego, e a utilização do deficiente como exemplo de bom trabalhador e fator de disciplinamento, em razão da sua superação de limites.

The author analyzes inclusion polices and practices for workers with disability within the labor market in Salvador, Bahia, Brazil. Disability is above all a social product, and work inclusion strategies adopted in Brazil are inadequate as they do not take into account relevant aspects of the world of labor and of the actors involved in it. In 2003, thirty five interviews were conducted with 22 workers with physical disability, six of their superiors and co-workers, and seven professionals and leaders of institutions concerned with workers disability. Specific legislation and employment statistics were analyzed, and institutions were visited, evidencing that the quota system for employment is not sufficient to ensure reasonable number of jobs for workers with disability. The author identified that inclusion strategies and practices are marked by situations that could be called inequality ironies, as, for example, the fact that superiors at work compel employees to treat persons with disability as normal people; that disability is considered as a virtue, as it facilitates job access; that workerswith disability are used as examples of good workers and discipline, due to their ability to overcome limitations.

Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva? / Bariatric surgery: is admission to the intensive care unit necessary?

OBJETIVOS: Determinar o local de internação no pós-operatório de cirurgia bariátrica primária e verificar as complicações clínicas-cirúrgicas que justificassem internação em unidade de terapia intensiva, inclusive morte. MÉTODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos à cirurgia bariátrica primária por vídeolaparoscopia no período de maio de 2007 a abril de 2008 em um hospital terciário. Utilizou-se o índice de Aldrete e Kroulik para liberação da sala de recuperação pós-anestésica e definição do local de encaminhamento no pós-operatório. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com média de idade 35,4 ± 10,5 anos (18 a 66 anos), índice de massa corpórea médio 45,6 ± 10,5. O tempo entre admissão hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirúrgico 105,0 ± 28,6 minutos, o tempo de permanência na sala de recuperação pós-anestésica foi 125,0 ± 38,0 minutos e tempo de internação hospitalar 47,7 ± 12,4 horas, com 100 por cento dos pacientes deambulando em 24 horas. O índice de Aldrete e Kroulik da sala de recuperação pós-anestésica alcançou pontuação de 10 com 120 minutos em todos os pacientes, com sobrevida de 100 por cento. CONCLUSÃO: Com o uso do índice Aldrete e Kroulik na sala de recuperação pós-anestésica de bypass gástrico por videolaparoscopia em cirurgia bariátrica primária, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicação maior foi observada.

OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was used for release from the post-anesthesia recovery room and to define where the patient should be routinely referred for postoperative. RESULTS: Among the 120 patients, 83 were women and 37 men with a mean age ranging from 35.4 ± 10.5 years (18 to 66 years), body mass index 45.6 ± 10.5. The time between hospital admission and start of surgery was 140.7 ± 81.8 minutes, surgery time was 105 ± 28.6 minutes, time of post-anesthesia recovery room was between 125 ± 38 minutes and length of hospital stay was 47.7 ± 12.4 hours, with 100 percent of the patients walking in 24 hours. The Aldrete and Kroulik index in the post-anesthesia recovery room achieved scores of 10 to 120 minutes in all patients, with a 100 percent survival . CONCLUSION: Using the Aldrete and Kroulik index in the post-anesthesia of gastric bypass by video laparoscopy in primary bariatric surgery, no patient was admitted in intensive care unit and no major complication was observed.

Uma visäo crítica do uso de padröes de exposiçäo na vigilância da saúde no trabalho / A critical view of the use of exposure standards in occupational health surveillance

Os limites de exposiçäo ocupacional a agentes químicos utilizados na indústria säo analisados no contexto da aplicaçäo reducionista que a medicina do trabalho faz dos conceitos de causa e norma. Säo discutidas algumas das lacunas técnico-científicas desses limites de exposiçäo, inclusive daqueles utilizados no Brasil, bem como seu uso como instrumentos de normalizaçäo do ambiente de trabalho.

Alterações do desenvolvimento dentofacial em pacientes da oncopediatria / Dentofacial development alterations in oncopediatric patients

No tratamento do câncer infantil, uma das principais armas utilizadas é a quimioterapia, quer isoladamente ou associada à cirurgia e à radioterapia. Como conseqüência, algumas complicações orais podem ser observadas, dentre elas uma série de seqüelas em função dos efeitos tardios da químio e da radioterapia. A odontogênese e o crescimento facial, comumente, são afetados durante o tratamento oncológico e, de acordo com a idade do paciente, surgirão malformações dentárias e hipodesenvolvimento dos ossos maxilares. Os autores relatam alterações dentofaciais em crianças que foram submetidas a químio e/ou radioterapia na época do desenvolvimento e crescimento dentocraniofacial, através de revisão da literatura dos últimos 10 anos e da apresentação de um caso clínico