Endoscopic posterior ventricular cordectomy with contact diode laser: how I do it.

BACKGROUND: The treatment of bilateral vocal fold paralysis is mainly surgical and several procedures can be used to guarantee adequate breathing. Furthermore, other causes of the narrowing of the natural airways could coexist and the treatment should consider all of them. METHODS: A supraglottic extension of posterior cordectomy to the false homolateral chord is described, which provides a further widening of the airway while maintaining acceptable voice quality. CONCLUSION: Endoscopic posterior ventricular cordectomy performed by contact diode laser may be a viable and safe option, especially in those patients who present bilateral vocal fold paralysis associated with various degrees of laryngospasm.

Neural stem/progenitor cells from olfactory neuroepithelium collected by nasal brushing as a cell model reflecting molecular and cellular dysfunctions in schizophrenia.

OBJECTIVES: Neural stem/progenitor cells derived from olfactory neuroepithelium (hereafter olfactory neural stem/progenitor cells, ONSPCs) are emerging as a potential tool in the exploration of psychiatric disorders. The present study intended to assess whether ONSPCs could help discern individuals with schizophrenia (SZ) from non-schizophrenic (NS) subjects by exploring specific cellular and molecular features. METHODS: ONSPCs were collected from 19 in-patients diagnosed with SZ and 31 NS individuals and propagated in basal medium. Mitochondrial ATP production, expression of ß-catenin and cell proliferation, which are described to be altered in SZ, were examined in freshly isolated or newly thawed ONSPCs after a few culture passages. RESULTS: SZ-ONSPCs exhibited a lower mitochondrial ATP production and insensitivity to agents capable of positively or negatively affecting ß-catenin expression with respect to NS-ONSPCs. As to proliferation, it declined in SZ-ONSPCs as the number of culture passages increased compared to a steady level of growth shown by NS-ONSPCs. CONCLUSIONS: The ease and safety of sample collection as well as the differences observed between NS- and SZ-ONSPCs, may lay the groundwork for a new approach to obtain biological material from a large number of living individuals and gain a better understanding of the mechanisms underlying SZ pathophysiology.

New insights into Trypanosoma cruzi genetic diversity, and its influence on parasite biology and clinical outcomes.

Chagas disease, caused by Trypanosoma cruzi, remains a serious public health problem worldwide. The parasite was subdivided into six distinct genetic groups, called "discrete typing units" (DTUs), from TcI to TcVI. Several studies have indicated that the heterogeneity of T. cruzi species directly affects the diversity of clinical manifestations of Chagas disease, control, diagnosis performance, and susceptibility to treatment. Thus, this review aims to describe how T. cruzi genetic diversity influences the biology of the parasite and/or clinical parameters in humans. Regarding the geographic dispersion of T. cruzi, evident differences were observed in the distribution of DTUs in distinct areas. For example, TcII is the main DTU detected in Brazilian patients from the central and southeastern regions, where there are also registers of TcVI as a secondary T. cruzi DTU. An important aspect observed in previous studies is that the genetic variability of T. cruzi can impact parasite infectivity, reproduction, and differentiation in the vectors. It has been proposed that T. cruzi DTU influences the host immune response and affects disease progression. Genetic aspects of the parasite play an important role in determining which host tissues will be infected, thus heavily influencing Chagas disease's pathogenesis. Several teams have investigated the correlation between T. cruzi DTU and the reactivation of Chagas disease. In agreement with these data, it is reasonable to suppose that the immunological condition of the patient, whether or not associated with the reactivation of the T. cruzi infection and the parasite strain, may have an important role in the pathogenesis of Chagas disease. In this context, understanding the genetics of T. cruzi and its biological and clinical implications will provide new knowledge that may contribute to additional strategies in the diagnosis and clinical outcome follow-up of patients with Chagas disease, in addition to the reactivation of immunocompromised patients infected with T. cruzi.

Operative technique: Tracheal resection and anastomosis in a revision surgery.

Tracheal stenosis is an uncommon pathological condition in which the lumen of the trachea is reduced. Within its management an adequate preoperative workup is crucial to determine the most appropriate procedure for each patient. In this scenario tracheal resection and anastomosis is a viable approach, as a procedure in which part of the trachea is removed and then restored with a tension-free anastomosis. It is usually indicated for extensive and high-grade lesions or when previous endoscopic procedures had failed. The patient here presented had already undergone a balloon dilatation twice and a tracheal resection and referred to our clinic with a residual tracheal stenosis graded Myer-Cotton 3 involving three tracheal rings. We here illustrate step-by-step the surgical procedure and highlight a peculiar way to perform the anastomosis, especially in a revision surgery.

Oxidized cellulose-based reaction mimicking thyroidal recurrence of disease: a case report and literature review.

Oxidized cellulose is a hemostatic agent currently used in surgery. Foreign body reactions have been described after its use. This paper describes a foreign body reaction caused by oxidized cellulose in a young woman who underwent thyroid surgery. A patient underwent two thyroid surgeries for treatment of papillary carcinoma. Five years after the last surgery, an asymptomatic mass was detected with a routine ultrasound in the left thyroid cavity. After surgical removal, the mass turned out to be a foreign body granuloma based on oxidized cellulose sheets used in the previous surgery. The patient was discharged from the hospital without complications. The follow-up period was uneventful. Oxidized cellulose is a useful tool in surgery to control and prevent intra and post-operative bleeding. Even if it is a biodegradable material, sometimes it persists in the human body causing foreign body reactions that can be misdiagnosed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03556-0.

Performance of microvesicles as biomarkers of clinical outcome in sepsis and trauma: A pilot study.

Sepsis remains one of the main causes of death in intensive care unit (ICU) worldwide, despite all technological and scientific advances. Microvesicles (MV) have become promising biomarkers for quick and accurate monitoring of several illnesses. The aim of this pilot study was to characterize and evaluate the performance of MV as biomarker of clinical outcome in septic and trauma patients. For this purpose, 39 subjects, both genders, aging from 18 to 85 years were included in three groups referred as Sepsis, Trauma and Healthy Control. Kinetic analysis of MV was carried out at four consecutive time points: admission (baseline)/T1, 24 h/T2, 72 h/T3 and outcome/T4 of discharge or death. At admission, an overall increase in total MV (Annexin V+) was observed in Sepsis.MV CD14+ (monocytes) was a putative biomarker to identify trauma patients, while MV CD3+ (T-cells) and CD41+ (platelets) were qualified to discriminated Trauma from Sepsis. Sepsis (Death) presented an increase in MV Annexin V+, CD45+, CD16+, CD14+, and CD41+ in comparison to Sepsis (Discharge). Moreover, Trauma (Death) presented an increase of MV CD3+ and CD235+ as compared to Trauma (Discharge). Analysing the ROC curve of specific MV evaluated according to performance, an accuracy of 100% was found to segregate the outcome in sepsis, and 95% in trauma. Our findings suggest that MV might be useful as a potential role in discriminating outcome in patients with sepsis/septic shock and trauma with high accuracy. However, further studies with a larger number of participants will be necessary to validate our findings.

Oropharyngeal Hairy Polyp: A Case of Respiratory Failure in a Newborn.

Hairy polyps, also known as dermoid polyps (DPs), are rare benign cystic lesions of bigerminal origin that may occur in several head and neck regions, including the oropharynx. Despite their benign histopathological nature, DPs may be life threatening, due to their upper airway location, and DPs represent one of the most unusual causes of respiratory distress during the neonatal period. In this paper, we describe a case of respiratory failure in a newborn with an oropharyngeal mass that was accidentally found during difficult intubation. Magnetic resonance imaging (MRI) detected a well-defined soft tissue pedunculated mass, arising from the left oropharynx wall, consistent with an oropharyngeal DP. The newborn had a prompt recovery after trans-oral mass removal. Our case underlines the importance of imaging in differential diagnosis of children's respiratory distress, secondary to a variety of lesions within the region of the skull base or oropharynx. It allowed us to assess the origin of the lesion, as well as its relationship with the adjacent soft tissues, and to exclude intracranial extension, thus providing essential information for the surgical planning.

Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes.

Ear, nose and throat (ENT) manifestations in granulomatosis with polyangiitis (GPA) represent the most frequent symptoms at disease onset. The aim of the study was to analyse ENT involvement at diagnosis, as well as how it could influence relapse rate, mortality and disease severity. A retrospective non-controlled cohort study was performed including all consecutive diagnosed GPA from 1996 to 2016 in two rheumatology centres of Northern Italy, focusing particularly on ENT presenting signs and symptoms at baseline. Eighty-nine patients (48.3% females) with new onset GPA were evaluated. They were mostly Caucasian (97.7%), middle aged (mean 54.5 years) and more frequently anti-neutrophil cytoplasmic antibodies (ANCA) positive (78.6%) with PR3 specificity (81.4%). At diagnosis, ENT involvement was reported in 71.9% patients, second only to systemic symptoms. These patients were significantly younger at disease onset (0.013), with less frequent renal involvement (0.014) irrespectively to ANCA status, but with significantly higher Vasculitis Damage Index (VDI) (0.001). The most frequent ENT manifestation was sinonasal involvement (58.4%, 73% of which with nasal inflammation/chronic sinusitis and 48% with nasal crusting), while otologic involvement (mainly otitis media/otomastoiditis) was observed in 34.8%. ENT-GPA patients presented a higher survival rate at 5 years (98.1 vs 77.7%, 0.049), and ENT involvement resulted to be an independent predictor of better outcome (OR 0.37, 95% CI 0.2-0.8, 0.019). Our data confirms that ENT involvement is not only one of the key clinical features of GPA, but also could point out a milder GPA subset with lower renal involvement and lower mortality rate, irrespectively to ANCA status.

Ethmoid osteoma with frontal and orbital extension: endoscopic removal and reconstruction.

Endoscopy provides a safe and effective way of treating craniofacial bony benign lesions. This approach permits not only complete removal of the tumour, but also reconstruction of the bony boundaries as necessary. Osteoma is a rare, osteogenic tumour that usually grows slowly and asymptomatically. It is the most frequent benign neoplasm of the nose and paranasal sinuses. Orbital extension is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debate persists regarding the optimal approach. We report the case of a bulky fronto-ethmo-orbital osteoma that was treated using an endoscopic trans-nasal approach. The medial wall of the orbit was repaired by means of an implant of porous polyethylene endoscopically positioned using an "underlay" technique. The surgical technique is described and the reasons for the endoscopic choice are also discussed. Fifteen days after the operation the patient reported complete resolution of craniofacial pain. Nasoendoscopy showed complete integration of the polyethylene implant in the healing tissue 4 weeks after surgery. A CT scan performed 6 months postoperatively showed good ventilation of the sinonasal cavity and effective reconstruction of the medial orbital wall.

Juventudes, trabalho e cultura em tempos de racionalidade neoliberal / Youths, work and culture in neoliberal rationality times

Resumo O presente artigo se debruça sobre a temática das juventudes enquanto importante categoria social, inscrita em um contexto de diversidade social interessada, em especial, nos grupos que mais sofrem com os efeitos da exclusão e da desigualdade. Temos que a expansão da lógica do atual modo social de produção capitalista e suas respostas diante das crises, como o neoliberalismo e a reestruturação das relações de trabalho, por exemplo, resultaram em mutações acerca do trabalho e das sociabilidades no mundo contemporâneo. Compreende-se, então, que a racionalidade neoliberal interfere diretamente na relação entre juventudes, trabalho e cultura e o presente texto apresenta análise crítica sobre como esse contexto interfere nos/as jovens trabalhadores/as da cultura. O trabalho no campo cultural se apresenta como possibilidade factível e também como potencializador para a essência criativa, novas subjetividades e formas de ser e estar no mundo, ao mesmo tempo em que enfrenta e reproduz os desafios da precarização e flexibilização e o próprio desemprego ou não trabalho como parte deste processo. Na terapia ocupacional se faz essencial investigar como a desigualdade, a exclusão e a exploração, intrínsecos ao capitalismo e à racionalidade neoliberal, interferem e alteram as ocupações, as atividades humanas e os cotidianos, sobretudo daqueles que mais vivenciam seus efeitos.

Abstract This article focuses on the theme of youth as an important social category, in a context of social diversity especially interested in the groups that suffer most the effects of exclusion and inequality. The expanded logic of the current social mode of capitalist production and its responses to crises such as neoliberalism and the restructuring of labor relations has resulted in mutations about work and sociability in the contemporary world. It is understood, then, that neoliberal rationality directly interferes in the relation between youths, work and culture and the present essay presents a critical analysis on how this context interferes in the young cultural workers. In the cultural field, labor is a feasible possibility and also enhances the creative essence, new subjectivities and ways of being and being in the world, at the time it faces and reproduces the challenges of precarious work and flexibilization and unemployment or not working as part of this process. In occupational therapy, it is essential to investigate how inequality, exclusion and exploitation intrinsic to capitalism and neoliberal rationality interferes and alters occupations, human activities and daily life, especially of those who most experience its effects.

Effectiveness of selective neck dissection in head and neck cancer: the experience of two Italian centers.

OBJECTIVE: The aim of this study was to evaluate the oncologic outcomes after a selective neck dissection (SND), both in elective and therapeutic settings, with particular regard to regional recurrence rate. METHODS: Retrospective analysis of 827 patients with head and neck primary tumors submitted to SND from 1999 to 2011 in two large hospital centers of northern Italy. RESULTS: A total of 40 neck recurrences were found in the whole series, with the same incidence after primary or salvage surgery (4.4% and 5.2%, respectively), but only 22 neck recurrences occurred in the same side of the dissected neck (3.0%). Factors predicting an increase of ipsilateral neck relapse were pathologically positive nodes, number of positive nodes, and nodal ratio (ratio between positive nodes and total nodal removed), but the risk of regional relapse did not exceed 5.0% in any subgroups. A total of 320 patients (39%) had postoperative radiotherapy (52.0% and 22.0% after primary and salvage surgery, respectively). Considering the primary surgery group alone, postoperative radiotherapy produced only a light reduction of homolateral neck recurrence rate in patients with pathological positive nodes (2.4% vs. 5.0%), but it impacted significantly disease-specific survival, both in pathological classification of nodes (pN)1 and pN2-3 patients. CONCLUSION: The SND can be considered a safe and sound procedure both in primary surgery and in salvage setting. Postoperative radiotherapy adds minor advantage to regional control only in node-positive patients but may impact survival. LEVEL OF EVIDENCE: 4.

La Terapia Ocupacional comunitaria para la promoción del arte y la cultura: reflexiones desde el proyecto Tienda Cultural / Community-based Occupational Therapy for the promotion of art and culture: reflections from the project Tienda Cultural / A Terapia Ocupacional comunitária para a promoção da arte e da cultura: reflexões a partir do projeto Tenda Cultural

Se presenta el proyecto de extensión universitaria Tienda Cultural: una ventana abierta para el arte, la ciencia y la ciudadanía, y las reflexiones derivadas de su implementación. Su objetivo fue promover, a partir del compromiso ético y político de la Terapia Ocupacional, la accesibilidad, la ciudadanía y la participación sociocultural a través de acciones artísticas, culturales y educativas. Fue una práctica de Terapia Ocupacional en el ámbito de la cultura desde una perspectiva comunitaria crítica y comprometida con la transformación social. La gestión cultural fue coordinada entre equipos transdisciplinarios y comunidades, y la programación se realizó en territorios periféricos de una ciudad mediana brasileña. Se incluyeron talleres artístico-culturales y educativos, exposiciones, cine, espectáculos con artistas y producciones culturales centradas en las demandas, los intereses y la producción artística de cada comunidad. Se generaron reflexiones sobre la cultura como derecho, el rol de la Terapia Ocupacional comunitaria y cultural, y la función social de la universidad pública. La Terapia Ocupacional y la cultura pueden contribuir a promover la diversidad, el reconocimiento y el acceso a la cultura; asimismo, a ampliar la participación social y la ciudadanía en estrecha colaboración con, para y desde las comunidades que enfrentan procesos de desigualdad y exclusión.

This article presents the university extension project "Cultural Store: an open window for art, science, and citizenship" and the reflections derived from its implementation. Based on Occupational Therapy's ethical and political commitment, the objectives were to promote accessibility, citizenship, and socio-cultural participation through artistic, cultural and educational activities. The project was an occupational therapy practice within a cultural environment from a critical community perspective, committed to social transformation. Cultural management was coordinated between transdisciplinary teams and communities, and the cultural programming was carried out in peripheral areas from a mid-sized Brazilian city. The programming included socio-cultural and educational workshops, exhibitions, cinema, shows with artists, and cultural productions focused on each community's demands, interests, and artistic production. The results generated reflections on culture as a right, the role of community and cultural Occupational Therapy, and the social function of the public university. Occupational Therapy and cultural activity can contribute to promote cultural diversity, recognition, and access. They also expand social participation and citizenship for communities experiencing exclusion and unequal processes, by intimately collaborating with, for, and within them.

Apresenta-se o projeto de extensão universitária "Tenda Cultural: janela aberta para arte, ciência e cidadania", assim como as reflexões derivadas de sua implementação. A partir do compromisso ético político da Terapia Ocupacional, seu objetivo foi promover acessibilidade, cidadania e participação sociocultural por meio de ações artísticas, culturais e educativas. Foi uma prática da Terapia Ocupacional no campo da cultura a partir de uma perspectiva critica comunitária e comprometida com a transformação social. A gestão cultural foi realizada entre equipes transdisciplinares e comunidades e a programação cultural em territórios periféricos de uma cidade de médio porte brasileira. A programação incluiu oficinas artístico-culturais e educativas, exposições, cine, espetáculos com artistas e produções culturais baseadas nas demandas, interesses e produção artística de cada comunidade. Os resultados demonstraram reflexões da cultura como direitos, o papel da Terapia Ocupacional comunitária e cultural e a função social da universidade pública. A Terapia Ocupacional e a cultura podem contribuir significativamente para a promoção da diversidade e o reconhecimento e acesso à cultura, assim como ampliar a participação social e a cidadania em consonância com, para e a partir das comunidades que enfrentam cotidianamente processos de desigualdades e exclusões.

Endoscopic treatment of upper airway and digestive tract lesions caused by caustic agents.

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.

Creative strategies and homeless people: occupational therapy, art, culture and sensitive displacement / Estratégias criativas e a população em situação de rua: terapia ocupacional, arte, cultura e deslocamentos sensíveis

Abstract The population that finds on the streets an alternative for their own survival and for sorting out their identities, is marked by a number of disruptions and violation of rights, resulting in vulnerability processes and social disaffiliation, given the current socioeconomic conditions and the neoliberal rationality. There is a need of innovative work that can add different sectors and knowledge, which defend the strengthening of a support network and services that aims the enfranchisement of the individuals, promote social participation and respect their diversity. Therefore, it is reported the experience of an extension project that promoted creative strategies to operate with the homeless from an arts and culture perspective. In order to do so, the weekly activities workshops promoted experimentations for the participants, aiming to express their potentialities, from the themes and requests relevant to the group, producing art, dynamics, and products that reflected the culture of the streets. Sensitive displacements were produced, noticeable to those involved, making the participants protagonists of their own expressions. The encounters took on creative proportions and composed new experiences of occupational therapeutic formation and practices in the social field. In defense of respect, appreciation of the human dimensions and capacities, especially of the groups in a vulnerable situation, associated with actions that aim to promote and extend their human and social rights.

Resumo A população que encontra nas ruas uma alternativa para sua sobrevivência e ordenação de suas identidades é marcada por inúmeras rupturas e violações de direitos, resultando em processos de vulnerabilidade e desfiliação social, dada as condições socioeconômicas e a racionalidade neoliberal vigente. Vimos a necessidade de trabalhos inovadores que possam agregar diferentes setores e saberes, que defendam o fortalecimento de rede de apoio e de serviços, que objetivem a emancipação dos sujeitos, promovam participação social e respeitem sua diversidade. Assim, relata-se a experiência de projeto de extensão que promoveu estratégias criativas para a atuação junto à população em situação de rua, a partir da arte e da cultura. Para tanto, as oficinas de atividades, realizadas semanalmente, promoveram experimentações aos participantes visando à expressão de suas potencialidades, a partir dos temas e demandas pertinentes ao grupo, produzindo arte, dinâmicas e produtos que refletiram a cultura da rua. Foram produzidos deslocamentos sensíveis, perceptíveis aos envolvidos, tornando os participantes protagonistas de suas expressões. Os encontros tomaram proporção criativa e se constituíram em novas experiências de formação e práticas terapêuticas ocupacionais no campo social. Na defesa do respeito, da valorização das dimensões e capacidades humanas, em especial de grupos vulneráveis, associadas às ações que buscam promover e ampliar seus direitos humanos e sociais.

Juventude, cultura e profissionalização da criatividade / Youth, culture and creativity professionalization

Este artigo integra reflexões sobre a juventude, o trabalho e a cultura a partir do conceito de profissionalização da criatividade. Afinal, a educação e o trabalho são temas centrais para a juventude que possui dificuldades reais de inserção, e a cultura tem sido apontada como essencial para o desenvolvimento das sociedades. Para tanto, apresenta-se uma pesquisa que teve o intuito de contribuir para a compreensão acerca de jovens gestores e produtores culturais por meio de um mapeamento na cidade de São Carlos (SP ­ Brasil). A metodologia consistiu em: i) mapeamento de programas, serviços e ações artístico- culturais dos diferentes setores, destinadas ou protagonizadas por jovens, com aplicação de um questionário específico; e ii) entrevistas com os artistas (15 a 29 anos), residentes na cidade e com interesse na profissionalização. Foram indicados 210 jovens artistas, realizadas 96 entrevistas e encontrados 46 jovens no perfil. As análises consideraram os artistas a partir de suas produções artísticas e das categorias: identificação, estrutura, profissionalização e financiamento. As demandas estiveram marcadas pela dificuldade de financiamento e gestão, o que acarreta numa precarização do trabalho em diferentes âmbitos. Ao mesmo tempo, sonhos, satisfação, cunho ideológico de transformação social e sublimação da vida fortalecem esses jovens na luta pela profissionalização de sua arte. Corrobora-se, portanto, com o investimento público para a cultura na direção do potencial transformador de processos culturais que produzem deslocamentos sensíveis. Além de estratégias visando ao desenvolvimento e ao impacto social, somando, portanto, importantes saberes e práticas para a terapia ocupacional.

This article links reflections on youth work and culture from the concept of the creativity professionalization. After all, education and work are central themes for youth with real insertion problems; and culture has been pointed as essential for societies' developments. Therefore, we present a search that aimed to contribute to the understanding of young managers and cultural producers through a mapping in the city of São Carlos (SP - Brazil). The methodology consisted of: i) mapping of programs, services and cultural artistic actions, from the different sectors, designed for or protagonized by young people, by applying a specific questionnaire; and ii) artists' interviews (15 to 29 years), living in the city and with professionalization interests. From the mapping of these sectors, 210 young artists were indicated, with 96 conducted interviews and 46 young matching the profile. The analysis considered the artists from their artistic productions and the categories: identification, structure, professionalization and financing. The demands were marked by the financing and management difficulty which results in work precariousness in different areas, at the same time, dreams, satisfaction, ideological social transformation and sublimation of life, strengthen these young people in the struggle for professionalization of their art. It contributes, therefore, with public investment for the culture toward the transformative potential of cultural processes that produce sensitive displacement. In addition to strategies for development and social impact, adding, therefore, important knowledge and practices for occupational therapy.

Grupo de mães de bebês prematuros hospitalizados: experiência de intervenção de Terapia Ocupacional no contexto hospitalar / Group of mothers of hospitalized premature newborns: experience of Occupational Therapy intervention in hospital context

The hospitalization of newborns implies fragility for the infants and their families, because they are exposed to the stress and tensions of this delicate moment. The support offered to the family, especially to mothers of hospitalized infants, may reflect in the future care provided to these children, strengthening the bond and creating a favorable environment for their healthy development. The objective of this study is to report the experience of occupational therapy in a group of mothers of hospitalized neonates. The aim of this activity was to provide information and guidance on the care and interaction of these mothers with their hospitalized babies. This practice was developed through an Extension Project in Occupational Therapy carried out in a hospital of a countryside city of the state of São Paulo. The Group of Mothers was joined weekly, and dynamics of artisanal, plastic and artistic activities were offered based on the demands observed or reported verbally by the mothers in meetings at the baby nursery before the group was joined. As a result of these group meetings, improvement of the emotional condition of the mothers was observed in the day they participated in the group. We believe that this project can not only facilitate the access to information and guidance to this population, but also minimize the stress experienced by families in the hospital context, which is strange and adverse to a natural birth condition.

A hospitalização do recém-nascido implica em fragilidade para o bebê e para a família, uma vez que ela fica exposta ao estresse e tensões desse momento delicado. O auxílio que se oferece aos familiares, em especial às mães dos bebês internados, pode refletir nos cuidados futuros à criança, fortalecendo o vínculo e criando um ambiente propício para seu desenvolvimento saudável. Objetiva-se explicitar por meio deste artigo uma experiência junto ao grupo de mães de neonatos hospitalizados. A realização dessa atividade visou promover informação e orientação sobre cuidados e interação dessas mães com seus bebês hospitalizados, prática vivenciada por meio da realização de um Projeto de Extensão em Terapia Ocupacional numa Santa Casa de Misericórdia do interior do estado de São Paulo. Tal atividade, Grupo de Mães, ocorre semanalmente, com o oferecimento de dinâmicas, atividades artesanais, artísticas e plásticas, selecionadas a partir das demandas observadas ou relatadas verbalmente pelas próprias mães nos momentos de encontro no berçário, antes da realização do encontro do Grupo. Como resultado desses encontros grupais, observou-se melhora na condição emocional das mães quando elas participavam do Grupo. Acredita-se que atividades dessa natureza possam facilitar o acesso à informação e orientação para esse público, bem como minimizar o estresse vivenciado pela família diante do contexto hospitalar: estranho e adverso a uma condição natural de nascimento.

Treatment of congenital subglottic hemangiomas: our experience compared with reports in the literature.

OBJECTIVE: To evaluate the outcome of our experience in the treatment of congenital subglottic hemangiomas. DESIGN: Retrospective review of records. SETTING: Airway tertiary care service. PATIENTS: From 1986 to 2006 we treated 39 pediatric patients affected by congenital subglottic hemangiomas. INTERVENTION: Therapeutic choice depended on presentation symptoms and grade of respiratory obstruction: 6 patients were primarily treated with only systemic steroids; 11 patients underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support; and 22 patients underwent primary diode laser treatment. MAIN OUTCOME MEASURE: The outcomes were evaluated according to 1 or more of the following criteria: resolution of symptoms, reduction of airway obstruction, the need and duration of intubation, tracheotomy decannulation, need of further treatments, and occurrence of complications. RESULTS: Patients treated with only systemic steroids showed a success rate of 50% (3 of 6); patients who underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support reached a positive result in 73% of cases (8 of 11). On the whole, 18% of patients treated with full-dose systemic steroids developed significant adverse effects (3 of 17). The success rate was 95% among patients treated with diode laser as primary treatment (21 of 22), with a complication rate of 9% (2 of 22). CONCLUSIONS: Endoscopic laser surgery is the therapeutic option that most approaches the objectives of securing the airway while using the least invasive method possible and reducing to a minimum the necessity and duration of intubation. On the basis of our experience, we believe that diode laser, owing to its physical and structural features, is the safest and most effective device for the treatment of congenital subglottic hemangiomas. Treatment with intralesional or systemic corticosteroids could have an adjuvant role.

Endoscopic stapler-assisted Zenker's diverticulotomy: which is the best operative facility?

BACKGROUND: Despite great changes in treatment for Zenker's diverticulum, endoscopic stapler-assisted diverticulotomy (ESD) has not yet been included on the lists of possible day-case procedures, and determining the best operative facility is still a matter of debate. The aim of this article was to evaluate the safety and feasibility of endoscopic treatment for patients with Zenker's diverticulum on a planned 24-hour-stay basis. METHODS: We retrospectively reviewed cases in which patients were admitted to and operated on at the Department of Airway Endoscopic Surgery of the Padua University Hospital over a 5-year period (January 2000 to December 2004). RESULTS: We considered 106 consecutive ESDs performed on 86 patients (1.23 procedures/patient). All procedures were planned on a 24-hour-stay basis ("1-day surgery"). In no case was the endoscopic procedure aborted. The mean operative time was 14 minutes (range, 5-45 minutes). Neither perioperative mortality nor major complications occurred. Minor complications were noted in 3 cases (2.8%). The mean time taken to resume oral intake was 0.83 days (range, 0-1). The mean hospital stay was 1.06 days (range, 0-5). Ninety-nine patients (93.4%) were discharged within the 24 hours after surgery. In no case was readmission necessary. CONCLUSIONS: We believe that ESD is a suitable operation for 1-day surgery. This facility, in fact, ensures the same outcome and safety conditions as with the inpatient procedure, making it possible to rationalize health resource management, reduce hospital costs, and improve patient comfort. In selected cases, ESD could be performed on an outpatient basis.