Características clínicas, diagnóstico e tratamento de mulher com síndrome de Meigs: relato de caso e revisão narrativa / Clinical characteristics, diagnosis and treatment of a woman with Meigs syndrome: case report and narrative review

O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.

To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.

Vestibular Syndromes in Childhood and Adolescence.

Introduction The prevalence of vestibular disorders in childhood ranges from 0.4% to 15%; they may be the result of several factors, but most of the time it's an episodic vestibular syndrome related to migraine equivalents. Objective To evaluate the diagnostic and therapeutic aspects of children with vestibular signs and symptoms. Methods The present cross-sectional study evaluated data from the records of patients treated in an outpatient pediatric neurotology clinic over a 10-year period. These data included sociodemographic and clinical variables, results of complementary examinations, the treatment provided, and the clinical evolution. Results The sample was composed of 117 patients, with 54.7% of female subjects with a mean age of 10 years. The most prevalent diagnosis was benign paroxysmal vertigo of childhood (BPVC) (41.9%), followed by vestibular migraine (16.2%). The most prevalent complaint was vertigo (53.9% of the cases). Most patients (66.7%) had inadequate eating habits. Improvement of symptoms was observed in 40.4% of the patients treated with dietary guidance alone. In 80% of the cases, dietary counseling in combination with vestibular rehabilitation therapy achieved therapeutic success without the need of a drug treatment. Conclusion The predominant diagnosis was of BPVC, and its close relationship with the personal and family history of migraine, its benign evolution, and the importance of dietary guidance and vestibular rehabilitation for therapeutic success were observed.

A Primary Clival Defect: Endoscopic Binostril Approach With Nasal Septal Flap Closure and Preservation of Septal Integrity.

Primary spontaneous cerebrospinal fluid (CSF) rhinorrhea is an unusual phenomenon that may occur anywhere along the skull base. However, CSF leaks originating from clival defects are rarely reported in the literature. The majority of reported cases were managed with microscopic techniques, using free grafts. The present study discusses a case of spontaneous CSF rhinorrhea from a clival defect closed with our transnasal operative approach using endoscopic techniques. The skull base defect was successfully managed with an endoscopic binostril approach to create a nasal septal flap pedicled at the sphenopalatine artery, while also preserving the integrity of the nasal septum.

Influência de Políticas de Ação Afirmativa no Perfil Sociodemográfico de Estudantes de Medicina de Universidade Brasileira / Influence of Affirmative Action Policies on Socio Demographic Profile of Medical Students from a Brazilian University

RESUMO A adoção de políticas públicas de inclusão pela Universidade Estadual de Campinas (Unicamp) desde o processo seletivo de 2005, atrelada às modificações nos vestibulares de 2014 e, mais recentemente, no de 2016, possivelmente trouxe grandes mudanças no perfil do estudante de Medicina dessa universidade. Desse modo, o objetivo do presente estudo é avaliar o perfil sociodemográfico desses acadêmicos, bem como suas pretensões na escolha da carreira médica e da futura especialidade. O estudo de corte transversal foi realizado com 290 acadêmicos do primeiro, terceiro e sexto ano da graduação médica da Unicamp por meio de um questionário anônimo aplicado após aprovação do Comitê de Ética em Pesquisa. Houve coleta de dados sociodemográficos, além dos fatores de influência para a escolha da profissão e da especialidade médica. A análise dos dados revelou uma amostra com idade média de 20-24 anos, predominantemente composta por mulheres (63,2%), da etnia branca (77,5%), procedentes do Estado de São Paulo (84,8%) e de regiões interioranas (62,3%). Para o primeiro ano, houve presença de negros (6,6%) e diferença estatística para pardos (22,6%), comparativa com o terceiro e sexto ano, egressos de ensino fundamental (42,5%) e médio (73,6%) públicos, com menor escolaridade materna (ensino médio) e renda familiar inferior (p < 0,001). Por sua vez, o terceiro e sexto ano eram compostos majoritariamente por alunos brancos (76,7% e 90,3%, respectivamente), oriundos de escola privada no ensino fundamental e médio, com maior escolaridade materna (ensino superior ou pós-graduação) e renda familiar mais elevada. Ainda, verificou-se variação das opções de especialidade ao longo do curso (p < 0,001). No primeiro ano, as especialidades mais pretendidas foram Cirurgia/Ortopedia (37,7%), Clínica Médica/Neurologia (23,6%) e Psiquiatria (11,3%). Para o terceiro ano, as especialidades mais desejadas foram Clínica Médica/Neurologia (40%), Cirurgia/Ortopedia (13,4%) e Ginecologia/Obstetrícia (13,3%). Entre os alunos do sexto ano, as especialidades mais escolhidas foram Clínica Médica/Neurologia (24,5%), Ginecologia/Obstetrícia (20,2%) e Cirurgia/Ortopedia (17%). Acadêmicos do primeiro ano também apresentaram diferentes aspirações abrangendo o local de trabalho futuro, com mais desejo de atuar somente no SUS ou em programas internacionais. Nesse contexto, os resultados apontam que a política de bonificação da Unicamp e suas alterações ao longo do tempo, em especial no vestibular de 2016, mostraram-se efetivas em democratizar o acesso à graduação médica, com maior pluralidade demográfica, social, econômica e étnica atreladas a variações na escolha da carreira e da especialidade médica ao longo das turmas analisadas.

ABSTRACT Affirmative action policies adopted by University of Campinas (Unicamp) in 2005 entrance exams, added to 2014 modifications, and more recently in 2016, lead to a big profile change of University of Campinas medical students. Therefore, this paper aims to describe academics' sociodemographic profile, as well as their aspirations in choice of medical career and future specialty. The cross-sectional study included 290 undergraduate years 1, 3 and 6 (Y1, Y3 and Y6) medical students from Unicamp who answered an anonymous questionnaire applied after approval by the Institutional Review Board. Socio demographic data and factors potentially influencing decisions on medical career and specialty choices were analyzed. Data analysis showed a sample composed mostly of white (77.5%), female (63.2%), 20-24 years population, from the State of São Paulo (84.8%) and interior (62.3%). For Y1, there was statistically significant difference for 'pardo' (22.6%) - it can be translated as brown - and black (6.6%) - there wasn't black in Y3 and Y6 - ethnic groups, public school provenience - both elementary school (42.5%) and high school (73.6%) -, lower maternal schooling (high school, p < 0.001) and lower family income (p < 0.001). Years 3 and 6 majority was composed of white academics (76.7% and 90.3%, respectively), coming from private schools (basic education and high school), with further maternal education (higher education/post-graduation) and bigger average income. The influence factors leading to choice for medical specialty modified (p < 0,001) among graduation years. Y1 students opted more frequently for 'surgery/orthopedics' (37.7%), 'medical clinic/neurology' (23.6%) and 'psychiatry' (11.3%). To Y3, the most desired specialties were 'medical clinic/neurology' (40%), 'surgery/orthopedics' (13.4%) and 'obstetrician-gynecologist' (13.3%). Amongst Y6 undergraduates, the most chosen specialties were 'medical clinic/neurology' (24.5%), 'obstetrician-gynecologist' (20.2%) and 'surgery/orthopedics' (17%). Y1 academics also revealed different aspirations regarding intended future workplace, with larger desire to practice only on SUS or on international programs. In this context, results indicate that Unicamp inclusion policy and its modifications over the years, particularly in 2016 entrance exams, have been effective in broadening access to medical education, such as greater socio demographic, economic and ethnic plurality coupled with variations in reasons for choice of medical career and specialty among graduation years analyzed.

Cost comparison of reusable and disposable air/water syringe tips in a large French teaching hospital

Air/water syringe (AWS) tips can be used in any type of dental care. They may be disposable (plastic) or reusable (stainless steel or plastic). We assessed the costs of using both sorts of tips in a French teaching hospital. A systematic use of one AWS tip per dental consultation was considered. Consultations performed with reusable AWS (stainless steel) tips give rise to costs linked to initial purchase of tips, their sterilisation, and replacement. Consultation costs of disposable AWS tips were calculated at their current purchase price. Replacing reusable tips was evaluat-ed in two different situations: annual replacement or replacement in case of visual deterioration. Results showed that the number of consultations must lie beyond a certain threshold in order to make reusable tips more economical in use than disposable counterparts. If the reusable tips are replaced every year, this threshold is higher (e.g.: 1,366consultations at the University of Bordeaux) than under a rule of tip replacement in case of visual deterioration (e.g. at the Bordeaux University: 1,267consultations in case of an annual replacement rate of 10%, or 1,289 with a re-placement rate of 30%). This is the first study regarding the costs of disposable versus reusable AWS tips. We suggest that disposable tips might be more cost-effective than reusable tips, not-ably because of their reduced risk of crosscontamination. The choice of the use of one or an-other AWS tip crucially depends on the number of consultations, as well as on their practical utilisation and on infection control issues.

Development of Seasonal Influenza Vaccination Recommendations: Relevance and Influence of the Evidence on the Decision-Making Process in France and the Netherlands.

BACKGROUND: Target groups for seasonal influenza vaccination are defined at the country level and are based on several factors. However, little is known about the national decision-making procedures. OBJECTIVE: The purpose of this study was to compare the evidence used for the development of recommendations and its impact on the choice of target groups in France and the Netherlands. METHODS: A preliminary documentary analysis identified institutions to include in the assessment: governmental authorities, research institutions, associations, and manufacturers. At least one expert from each group was invited to our study. Thirty-three semi-structured interviews were conducted in 2013 (16 France, 17 the Netherlands). We used NVivo10® to perform a thematic content analysis. RESULTS: Clinical/epidemiological studies were the evidence most used in both countries. Economic models were increasingly being used; these had greater influence on the decision making in the Netherlands than in France, probably because of the presence of a modeler. Generally, the quality of the evidence used was poor, although no systematic use of standard protocol for its assessment was observed. A general protocol was sometimes used in France; however, the personal judgment of the experts was crucial for the assessment in both countries. CONCLUSIONS: There were differences in the target groups, for example, pregnant women, recommended only in France. France and the Netherlands use similar evidence for developing vaccination recommendations, although different decisions are sometimes made regarding target groups. This could be associated with the lack of systematic standard appraisals, increasing the influence of the experts' judgment on decision making. The development of standards for the appraisal of evidence is recommended.

Influenza vaccination policy-making processes in France and The Netherlands: Framework and determinants.

OBJECTIVES: Target groups for seasonal influenza vaccination are nationally defined based on several factors. However, few studies have explored the policy-making processes at the country-level. We investigated key differences in the policy-making process for the development of vaccination recommendations between France (FR) and The Netherlands (NL). This paper presents preliminary results on the evidence used in the decision-making process and focuses on the interactions between the experts and stakeholders. METHODS: A documentary analysis identified the stakeholders of this process as governmental authorities, research institutions, associations, and manufacturers. This qualitative study included at least one expert from each stakeholder group. Thirty-three semi-structured interviews were performed in 2013 (16 FR, 17 NL). We used NVivo10® to perform a thematic content analysis on the data. RESULTS: National Immunization Technical Advisory Groups (NITAGs) were the key stakeholders in the development of recommendations. There was no systematic standard evaluation of evidence during the decision-making process in both countries. Likewise, voting was not systematic, although it did occur more often in FR. A declaration of interests was obligatory in both countries. Experts with no conflicts of interest were rare because many depend on private funding for their research on influenza vaccination. CONCLUSIONS: The transparency of the NITAGs' procedures for the development of recommendations should be improved. We believe improvements might be achieved by the systematic standard evaluation of evidence, consistent voting, clear declarations of interest, and increased public funding for vaccination research.

Striking Similarities in the Presentation and Duration of Illness of Influenza A and B in the Community: A Study Based on Sentinel Surveillance Networks in France and Turkey, 2010-2012.

Influenza B represents a high proportion of influenza cases in some seasons (even over 50%). The Influenza B study in General Practice (IBGP) is a multicenter study providing information about the clinical, demographic and socio-economic characteristics of patients affected by lab-confirmed influenza A or B. Influenza B patients and age-matched influenza A patients were recruited within the sentinel surveillance networks of France and Turkey in 2010-11 and 2011-12 seasons. Data were collected for each patient at the swab test day, after 9±2 days and, if not recovered, after 28±5 days. It was related to patient's characteristics, symptoms at presentation, vaccination status, prescriptions of antibiotics and antivirals, duration of illness, follow-up consultations in general practice or emergency room. We performed descriptive analyses and developed a multiple regression model to investigate the effect of patients and disease characteristics on the duration of illness. Overall, 774 influenza cases were included in the study: 419 influenza B cases (209 in France and 210 in Turkey) and 355 influenza A cases (205 in France and 150 in Turkey). There were no differences between influenza A and B patients in terms of clinical presentation and number of consultations with a practitioner; however, the use of antivirals was higher among influenza B patients in both countries. The average (median) reported duration of illness in the age groups 0-14 years, 15-64 years and 65+ years was 7.4 (6), 8.7 (8) and 10.5 (9) days in France, and 6.3 (6), 8.2 (7) and 9.2 (6) days in Turkey; it increased with age but did not differ by virus type; increased duration of illness was associated with antibiotics prescription. In conclusion, our findings show that influenza B infection appears not to be milder disease than influenza A infection.

A literature review to identify factors that determine policies for influenza vaccination.

OBJECTIVES: To conduct a literature review of influenza vaccination policy, describing roles and interactions between stakeholders and the factors influencing policy-making. METHODS: Major databases were searched using keywords related to influenza vaccination, decision-making and health policy. Titles and abstracts were screened according to defined criteria using independent reviewers. Selected articles were analysed and compared against a checklist. RESULTS: 342 papers were identified, but only 111 included. A wide range of countries was represented in articles published in 1994-2012. We identified numerous stakeholders at the national and international level and found a variety of interactions between them. Using these data, we suggest a scheme for the most important stakeholders and their interactions. Determinants of policy-making were mainly related to the vaccine/disease, political-economic context, and stakeholders communication. The most relevant evidence was clinical/epidemiological studies. After the 2009 pandemic: the importance of mathematical modelling and ethical issues was greater; and the need for better communication between stakeholders was emphasised. CONCLUSIONS: The relevance of evidence and factors influencing policy-making varied between countries, according to complex interactions between the stakeholders involved at different levels of decision-making process. These interactions remain unclear, especially at national level, where the most important influenza policy decisions are made. To better define and understand the exact interactions and use of evidence, we recommend undertaking future qualitative studies at national level using small number of countries.

General Characteristics, Phytochemistry and Pharmacognosy of Lippia sidoides.

Lippia sidoides Cham. is a plant that belongs to the family Verbenaceac and is commonly known as "alecrim-pimenta". It was first found in northeastern Brazil, where it is extensively used in traditional medicine. Many studies have been made with the essential oil of L. sidoides, which has a high content of the isomeric compounds thymol and carvacrol. L. sidoides extracts, and particularly the essential oil extracted from its aerial parts, have shown many biological activities such as antifungal, antibacterial, and insecticidal. Given the great biological potentialities of L. sidoides and the amount of recent studies about this plant, the present study aimed to make a survey of its general attributes, cultivation methods, chemical characterization of its extracts and essential oil, as well as its different biological activities.

Economic burden of seasonal influenza B in France during winter 2010-2011.

BACKGROUND: In France, 2-15% of the population is affected annually by influenza, which causes significant socioeconomic disruption. Nevertheless, despite its importance for policy makers, few published studies have evaluated the impact of influenza B. Therefore, we assessed the costs associated with influenza B during 2010-2011 in France. METHODS: Cases of lab-confirmed influenza B were analyzed as part of the Influenza B in General Practice Study. Cost calculations were based on micro-costing methods according to the French Health Insurance (FHI) perspective (in Euros, 2011). Costs were compared between age groups using the Kruskal-Wallis test, and when significant, by multiple comparisons based on rank. Moreover, uncertainties were assessed using one-way sensitivity and probabilistic analyses. Overall economic burden was estimated by multiplying cost per patient, flu attack rate, and the French population. RESULTS: A total of 201 patients were included in the study. We found that the mean cost associated with Influenza B was 72€ (SD: 205) per patient: 70€ (SD: 262) for younger children, 50€ (SD: 195) for older children, 126€ (SD: 180) for adults, and 42€ (SD: 18) for elderly. Thus, we observed significantly different costs between the distinct age groups (p<0.0001). Finally, the economic burden of influenza B for the FHI was estimated to be 145 million Euros (95% CI: 88-201). CONCLUSIONS: Our findings highlight the important impact of influenza B and encourage further investigation on policy regarding vaccination strategies in France.

The impact of acute loss of weight on eustachian tube function.

Introduction The eustachian tube is one of the key structures responsible for the functional balance of the middle ear. Some clinical conditions associated with tubal malfunction can cause extremely unpleasant symptoms. These symptoms could be triggered by acute loss of weight, for example, after bariatric surgery. Objective To evaluate the frequency and intensity of auditory tube dysfunction symptoms in obese patients after bariatric surgery. Methods Nineteen patients with accepted formal indications for bariatric surgery underwent a hearing evaluation (otoscopy, tonal and vocal audiometry, and impedanceometry) and a hearing questionnaire before, at the time of, 3 months after surgery (first postoperative evaluation), and 6 months (second postoperative evaluation) after surgery. Patients with a history of ear disease or ear surgery were excluded. Results None of the patients reported tubal dysfunction symptoms before surgery. Postsurgical results showed that 5 (26.3%) patients presented symptoms related to dysfunction of the eustachian tube at the first postoperative evaluation. After the 6-month follow-up, 9 (47.3%) patients reported symptoms of tubal dysfunction. Conclusion This study suggests that bariatric surgery can cause symptoms of eustachian tube dysfunction, probably due to rapid weight loss and the consequent loss of peritubal fat.

The Impact of Acute Loss of Weight on Eustachian Tube Function

Introduction The eustachian tube is one of the key structures responsible for the functional balance of the middle ear. Some clinical conditions associated with tubal malfunction can cause extremely unpleasant symptoms. These symptoms could be triggered by acute loss of weight, for example, after bariatric surgery. Objective To evaluate the frequency and intensity of auditory tube dysfunction symptoms in obese patients after bariatric surgery. Methods Nineteen patients with accepted formal indications for bariatric surgery underwent a hearing evaluation (otoscopy, tonal and vocal audiometry, and impedanceometry) and a hearing questionnaire before, at the time of, 3 months after surgery (first postoperative evaluation), and 6 months (second postoperative evaluation) after surgery. Patients with a history of ear disease or ear surgery were excluded. Results None of the patients reported tubal dysfunction symptoms before surgery. Postsurgical results showed that 5 (26.3%) patients presented symptoms related to dysfunction of the eustachian tube at the first postoperative evaluation. After the 6- month follow-up, 9 (47.3%) patients reported symptoms of tubal dysfunction. Conclusion This study suggests that bariatric surgery can cause symptoms of eustachian tube dysfunction, probably due to rapid weight loss and the consequent loss of peritubal fat...

Cirurgia endoscópica de ouvido: aplicações e resultados preliminares / Ear endoscopic eurgery: aplications and preliminary results

Introdução e objetivos: Endoscópios são equipamentos utilizados com sucesso em diversos procedimentos de várias especialidades médicas. Entretanto, na área da otologia, mesmo com a incorporação dos endoscópios em procedimentos conjuntos com microscópio, os procedimentos puramente assistidos por endoscopia ainda são muito limitados. Nosso trabalho tem como objetivos demonstrar os procedimentos otológicos puramente endoscópicos realizados em nosso serviço e apresentar nossos resultados preliminares. Métodos: De outubro de 2007 até junho de 2009 fizemos revisão de cinco pacientes, quatro do sexo masculino e um feminino, com idades variando entre 7 e 54 anos de idade, selecionados para a realização de procedimentos otológicos puramente endoscópicos. Desenho do estudo: Retrospectivo. Resultados: Todos os pacientes apresentaram melhora da sintomatologia e correções das alterações em exame físico pré-operatório após a realização do procedimento endoscópico. Não houve complicações. Conclusões: A realização de procedimentos puramente endoscópicos em cirurgias otológicas é possível e pode apresentar algumas vantagens em relação ao uso de microscópios, dependendo principalmente do tipo e extensão de doença apresentada. Apresentamos nossa casuística, mostrando nossos resultados preliminares. Entretanto estudos com maior número de procedimentos são necessários para uma completa desmistificação destes instrumentos, que podem ser bastante úteis também na otologia.

Distúrbios respiratórios do sono: como identificar / Sleep breathing disorders: how to identify

Os distúrbios respiratórios do sono são doenças altamente prevalentes com grande impacto na qualidade de vida dos pacientes. Em grande parte dos casos não podemos estabelecer o diagnóstico e a gravidade do caso, baseando-nos apenas nos achados clínicos. Dessa forma torna-se imperativo a complementação diagnóstica com a polissonografia. O diagnóstico preciso permite um melhor planejamento terapêutico, elevando o sucesso do tratamento. Este artigo se propõe a revisar aspectos clínicos e diagnósticos dos distúrbios respiratórios do sono com ênfase na interpretação da polissonografia.

Is the information available on the Web influencing the way parents see ENT surgical procedures?

INTRODUCTION AND AIMS: the Internet is the world's fastest growing source of health related information. Parents and guardians are increasingly turning to the Internet for information about their children's medical conditions and treatments. This paper has the following objectives 1) determine the prevalence of web searches for medical information performed by parents/guardians of children undergoing ENT surgery in a private hospital of Sao Paulo, Brazil. 2) assess whether the gathered information influenced the parents/guardians' decision on the treatment/surgery. METHOD: questionnaire voluntarily responded by 132 parents/guardians of children submitted to ENT surgery in a private hospital in Sao Paulo, Brazil. CONCLUSIONS: 117 parents/guardians (90%) used the Internet to search for information on the disease and surgical treatment of the children. Only 12 parents/guardians (10%) discussed the information with the physician assigned to perform the surgical procedure. 91 parents/guardians (78%) said that the information had impact upon the decision to have surgery performed on their children.

Is the information available on the Web influencing the way parents see ENT surgical procedures? / Informações da internet estão influenciando a decisão dos pais na realização de cirurgias otorrinolaringológicas?

INTRODUCTION AND AIMS: the Internet is the world's fastest growing source of health related information. Parents and guardians are increasingly turning to the Internet for information about their children's medical conditions and treatments. This paper has the following objectives 1) determine the prevalence of web searches for medical information performed by parents/guardians of children undergoing ENT surgery in a private hospital of Sao Paulo, Brazil. 2) assess whether the gathered information influenced the parents/guardians' decision on the treatment/surgery. METHOD: questionnaire voluntarily responded by 132 parents/guardians of children submitted to ENT surgery in a private hospital in Sao Paulo, Brazil. CONCLUSIONS: 117 parents/guardians (90 percent) used the Internet to search for information on the disease and surgical treatment of the children. Only 12 parents/guardians (10 percent) discussed the information with the physician assigned to perform the surgical procedure. 91 parents/guardians (78 percent) said that the information had impact upon the decision to have surgery performed on their children.

INTRODUÇÃO E OBJETIVOS: A Internet é a fonte de informação relacionada à saúde que mais cresce atualmente. Pais ou responsáveis estão cada vez mais buscando a rede mundial de computadores para pesquisa sobre doenças e tratamentos para filhos ou dependentes. Nosso trabalho tem por objetivos: 1) determinar a prevalência de procura sobre informações médicas na Internet por pais/responsáveis de crianças submetidas a cirurgias otorrinolaringológicas em hospital privado de São Paulo, Brasil. 2) avaliar se estas informações influenciaram os pais/responsáveis quanto à decisão médica. MÉTODO: Questionário respondido voluntariamente por 132 pais/responsáveis de crianças submetidas a cirurgias otorrinolaringológicas em hospital privado de São Paulo, Brasil. CONCLUSÕES: 117 pais (90 por cento) utilizaram a Internet para procurar informações sobre a doença e tratamento cirúrgico dos filhos. Somente 12 parentes (10 por cento) discutiram as informações adquiridas com o médico que realizou o procedimento cirúrgico. Entretanto, 91 (78 por cento) afirmaram que as informações influenciaram as decisões sobre os procedimentos a serem realizados em filhos/dependentes. Otorrinolaringologistas devem estar conscientes do crescente uso da Internet como fonte de informações médicas e do conteúdo de páginas específicas com informações confiáveis e de fácil acesso para direcionarem pacientes, além de discutirem estas informações.

Sinuplastia com balão: um novo conceito na cirurgia endoscópica nasal / Balloon sinuplasty: a new concept in the endoscopic nasal surgery

Introdução: Doenças sinusais afetam milhões de pessoas anualmente. Na maioria dos pacientes o tratamento clínico é eficaz, mas em casos de falha desta terapêutica a cirurgia endoscópica funcional é o atual método de escolha para tratamento cirúrgico. O objetivo da cirurgia endoscópica funcional é a aumentar a ventilação e drenagem dos seios paranasais envolvidos permitindo o retorno do funcionamento adequado dos movimentos mucociliares da mucosa nasal. Entretanto este método ainda apresenta algumas limitações, principalmente porque remove mucosa nasal e tecido ósseo, o que pode levar à alterações fisiológicas da mucosa nasossinusal e fibrose cicatricial. Muitos destes poderiam ser beneficiados com métodos menos invasivos, com maior preservação de mucosa nasal. A partir de 2006, um procedimento ainda menos invasivo ganhou destaque em nossa especialidade: a dilatação por balões dos óstios dos seios paranasais. Objetivo: Este artigo tem por objetivos: definir o conceito de sinuplastia, mecanismo de ação e apresentar o material necessário para realização de procedimentos; descrever as técnicas utilizadas com o equipamento em modelo simulador de cirurgia endoscópica nasossinusal e revisar na literatura atual, as indicações, complicações, resultados e seguimento de pacientes submetidos a este procedimento. A sinuplastia com balão é segura e parece ser efetiva na melhoria da qualidade de vida de pacientes não responsivos aos tratamentos clínicos convencionais. Novas aplicações e indicações para estes equipamentos devem ser trazidos e pesquisados.

Introduction: Sinus diseases affect millions of people annually. Clinical treatment is effective in most patients, but in case of failure of this therapy the functional endoscopic surgery is currently the treatment choice for surgical treatment. The objective of the functional endoscopic surgery is to increase the aeration and drainage of the involved paranasal sinuses, which allows for the adequate functioning of the nasal mucosa mucociliary clearance. However, this method still has some limitations, mainly because it removes the nasal mucosa and bone tissue, and it may lead to physiologic alterations of the nasosinusal mucosa and cicatricial fibrosis. Many of these patients could be benefited from less invasive methods, with larger nasal mucosa preservation. Since 2006, an even less invasive procedure was remarked in our specialty: the balloon dilatation of the paranasal sinus ostia. Objective: The objective of this article is to define the concept of sinuplasty, its action mechanism, and present the necessary material for the procedures performance; to describe the techniques with the equipment in a nasosinusal endoscopic surgery simulator model and review the current literature about the indications, complications, results, and follow-up of patients submitted to this procedure. Balloon sinuplasty is safe and appears to be effective in the improvement of the quality of life of patients not responsive to conventional clinical therapy. New applications and indications for this equipment should be described and researched.