Competing with injuries: injuries prior to and during the 15th FINA World Championships 2013 (aquatics).

BACKGROUND: Injury and illness surveillance is the foundation for the development of prevention strategies. OBJECTIVE: To examine injuries among the aquatic disciplines in the 4 weeks prior to and during the 2013 FINA World Championships. METHODS: The study was comprised of two components: (1) a retrospective athlete survey recording injuries in the 4 weeks prior to the Championships and (2) a prospective recording of injuries and illnesses by the medical teams of the participating countries and the local host medical team. RESULTS: One-third of the 1116 responding athletes reported an injury/physical complaint in the 4 weeks prior to the Championships. Significantly more women (36.7%) than men (28.6%) reported injuries. Divers reported the highest rate of injury/physical complaints (55.7%). At the start of the Championships, 70% of injured respondents (n=258) were still symptomatic; however, full participation was expected by 76%. During the Championships, 186 new injuries were reported (8.3/100 registered athletes) with the highest injury incidence rate in water polo (15.3/100 registered athletes). The most common injured body part was the shoulder (21%). A total of 199 illnesses were reported during the Championships (9.0/100 registered athletes) with the most common diagnosis of illness being gastrointestinal infection. Environmental exposure (allergy, otitis and jellyfish stings) was responsible for 27% of all illnesses in open water swimming. CONCLUSIONS: Injuries pose a significant health risk for elite aquatic athletes. A prospective study would improve understanding of out-of-competition injuries. Future injury and illness surveillance at FINA World Championships is required to direct and measure the impact of prevention strategies.

Three-Dimensional Volume Imaging to Increase the Accuracy of Surgical Management in a Case of Recurrent Chordoma of the Clivus.

BACKGROUND The clivus is a depression in the anterior occipital bone of the skull base, posterior to the dorsum sellae, at the junction with the sphenoid bone. Chordoma is a rare tumor arising from embryonic remnants of the notochord and can be locally aggressive with a tendency to recur. The optimal management of this rare tumor remains controversial. A report of a case of recurrent chordoma of the clivus is presented to illustrate the value of volumetric three-dimensional (3-D) reconstruction with computed tomography (CT) and magnetic resonance imaging (MRI) to determine optimal surgical management. CASE REPORT A 53-year-old man presented with pain in the right orbital cavity, right proptosis, swelling of the right cheek, and bilateral loss of vision. He also had adrenal insufficiency. CT and contrast-enhanced (gadolinium) T1-weighted MRI with multiplanar acquisition were performed with volumetric 3-D reconstruction of the tumor, to increase the chances of treatment success. Surgical resection was performed to remove the tumor and reduce the risk of recurrence. Histology of the tumor was consistent with chordoma, supported by positive immunohistochemical staining for S-100 and epithelial membrane antigen (EMA). CONCLUSIONS This report highlighted the value of 3-D volume imaging in the diagnosis and treatment planning in a rare case of recurrent chordoma of the clivus. Analysis of tumor volume may be an indicator of the efficacy of surgery, complementing the Response Evaluation Criteria In Solid Tumors (RECIST) system and as a valuable tool to predict treatment outcome.

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study.

OBJECTIVE: This study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses. DESIGN: Three-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 16, using 5% as a critical p-value. RESULTS: A significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (p < 0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (p < 0.01). CONCLUSION: The current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

[Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation]. / Participação da sociedade civil no seguimento das ações frente à Aids no Brasil.

The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/Aids [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested.

Emergency Department greeters reduce door-to-ECG time.

INTRODUCTION: Screening for Acute Coronary Syndrome in chest pain patients can be initiated with a 12-lead electrocardiogram (ECG). Current American College of Cardiology/American Heart Association guidelines recommends getting an ECG performed and reviewed within 10 minutes of the time these patients present to the Emergency Department (ED). One innovative method to improve door-to-ECG time is by placing a trained greeter in the triage section of the ED. METHODS: This study was conducted over a 3-week period from September to October 2006, in a large urban academic medical center. The greeter was stationed in the triage area, and screened every patient entering the ED for the following symptoms/complaints: chest pain, shortness of breath, acute mental status changes in nursing home patients, dizziness, and nausea with or without vomiting in diabetic patients. The greeter obtained the ECG in the qualified patients, or alerted the triage. Data was collected on ECGs for all ED patients who presented with the above complaints in the absence of a greeter. RESULTS: In the 3 weeks of the study, data was collected on 126 cases. The greeter had obtained 40 ECGs, and 86 ECGs were done without the greeter. The average door-to-ECG times were significantly different between the groups. The study found 8.8 minutes in the greeter group versus 29.6 minutes in the nongreeter group (P = 0.000). CONCLUSION: ED triage greeter can be effectively used to obtain timely ECGs in suspected Acute Coronary Syndrome patients.

Uso da LIPE® como indicador externo na determinação da digestibilidade da proteína e matéria seca de alimentos em frangos de corte / Use of LIPE® as an external indicator in the determination of protein and dry matter digestibility of broiler chicken food

Realizou-se um ensaio metabólico para avaliar a lignina purificada de eucalipto (LIPE®), como indicador na determinação da digestibilidade da proteína bruta e matéria seca de alimentos para frangos de corte. Os tratamentos corresponderam a uma dieta basal e outras oito dietas contendo os alimentos-teste. Os alimentos foram: milho, milho expandido, farelo de soja, farelo de soja expandido, glúten de milho 22 por cento, glúten de milho 60 por cento, farinha de carne e ossos e farinha de penas e vísceras. Os alimentos protéicos e os com menor teor de proteína substituíram 25 e 40 por cento da dieta basal, respectivamente. Foram utilizados 270 pintos de corte, linhagem Ross, de ambos os sexos, dos 21 aos 31 dias de idade. Utilizou-se um delineamento experimental inteiramente ao acaso em esquema fatorial 9×3 (rações × métodos), com três repetições. Os coeficientes de digestibilidade (CD) da proteína e da matéria seca e os valores da proteína bruta digestível e da matéria seca digestível de sete das nove dietas, calculados pelos métodos da coleta total de excretas e dos indicadores óxido crômico e LIPE®, foram semelhantes. Com os alimentos-teste, farelo de soja expandido e farinha de penas e vísceras, o uso de óxido crômico resultou em CD e valores de proteína e matéria seca digestível mais altos, quando comparado com o uso da LIPE® e da coleta total de excretas que foram semelhantes entre si. Pode-se considerar que a proteína bruta digestível e matéria seca digestível dos alimentos, calculada pelos três métodos, foram equivalentes. A LIPE® pode ser validada como indicador de digestibilidade da proteína e matéria seca de alimentos para frangos de corte.

A metabolism experiment was carried out to evaluate the use of LIPE® as an external indicator of dry matter and protein digestibility in broilers. The treatments corresponded to a basal diet and eight other different diets. The foods used were: corn grain, expanded corn, soybean meal, expanded soybean meal, gluten meal 22 percent crude protein; gluten meal 60 percent crude protein, meat and bone meal and feather meal. The basal diet was replaced with 40 percent or 25 percent of the food containing more energy or protein, respectively. Two hundred and seventy broiler chickens were used from 21 to 31 days old. A completely randomized design in a 9x3 factorial arrangement (nine forms of rations x three methods) with three replicates was used. The digestible dry matter and protein and metabolizable energy of the food was calculated by the total fecal collection method and by the indicator methods of chromic oxide and LIPE®; the three methods were further compared. Chromic oxide use resulted in higher values of coefficient of digestibility for expanded soybean meal and feathers and viscera meal when compared to the use of LIPE® and total feces collection which were similar. The results validated the LIPE® as an external protein and dry matter digestibility index of the feed of broiler chicks evaluated.

Valor da dosagem da tireoglobulina no seguimento de pacientes com carcinoma diferenciado da tireóide submetidos à tireoidectomia parcial / Value of serum thyroglobulin measuremat in the follow-up of patients with differentiated carcinoma treated by partial thyroidectomy

OBJETIVO: Estudar o valor da dosagem da tireoglobulina (Tg) plasmática na detecção de recidivas, nos pacientes com carcinoma diferenciado da tireóide, submetidos à tireoidectomia parcial. MÉTODOS: São analisados, retrospectivamente, 48 pacientes portadores de carcinoma diferenciado e submetidos à tireoidectomia parcial que foram acompanhados no pós-operatório com dosagens de Tg plasmática. O exame foi realizado no paciente com TSH suprimido (< 0,6mU/cc) e o valor da Tg de 10ng/cc considerado como limite entre os casos com e sem suspeita de recidiva. O tempo médio de seguimento foi de 8,1 anos. RESULTADOS: Onze pacientes apresentaram Tg elevada (> 10ng/cc) e quatro eram portadores de doença benigna capaz de elevar a Tg como hipertireoidismo (dois casos) e doença de Hashimoto (dois casos). Estes quatro pacientes não foram considerados na análise estatística. Os sete restantes foram considerados suspeitos de recidiva tumoral que foi confirmada em seis (verdadeiro positivo) e não confirmada em um (falso positivo). Nos 37 pacientes com Tg baixa (< 10ng/cc) apenas um apresentou recidiva (verdadeiro negativo: 36 e falso negativo: 1). A análise estatística da capacidade da Tg em detectar recidivas mostrou: sensibilidade 85 por cento; especificidade 94 por cento; valor preditivo positivo 85 por cento; valor preditivo negativo 84 por cento e acurácia 95 por cento. CONCLUSÕES: Os resultados obtidos neste trabalho mostraram que a dosagem da Tg é de valor na detecção de possibilidade de recidivas no seguimento de pacientes operados por carcinoma diferenciado mesmo quando submetidos à cirurgia parcial.

BACKGROUND: Serum thyroglobulin determination has been reported to be a sensitive indicator of recurrent differentiated thyroid carcinoma. The purpose of this study is to determine the accuracy of serum thyroglobulin levels in predicting tumor recurrency after parcial thyroidectomy. METHODS: Forty eight patients with differentiated thyroid carcinoma were followed with serum thyroglobulin measurement after parcial thyroidectomy. Patiens recived hormonal suppressive therapy to maintain plasma TSH level below 0,6 mU/cc. Mean follow-up was 8,1 years. Serum thyroglobulin level above 10ng/cc was considered suspect of tumor recurrency. RESULTS: Eleven patients showed serum thyroglobulin level above 10 ng/cc. In four of them, elevations were considered spurious (hiparthyroidisme - 2 cases, and Hashimoto disease - 2 cases) and were excluded from statistical analysis. In the other 7, tumor recurrence was demonstrated in 6 (true positive: 6; false positive: 1). In 37 patients with low thyroglobulin level, only 1 had recurrence (true negative: 36; false negative: 1). Statistical analysis show sensibility 85 percent, specificity 94 percent, positive predictive value 85 percent, negative predictive value 84 percent and accuracy 95 percent. CONCLUSIONS: Serum thyroglobulin determination is an useful test to identify patients with persistent or recurrent differenctiated cancer, inicially submited to parcial thyroidectomy.

Vascularizaçao parietal do colon sigmoide / Parietal vascularization of sigmoid colon

Este trabalho tem como objetivo identificar com riqueza de detalhes a vascularizaçao parietal do colon sigmoide. Foram utilizadas oitopeças de necropsia de humanos, no segmento sigmoidiano do colon. Em quatro peçasfez-se o estudo angioplastico, com injeçao de acetato de vinil e posterior corrosao. Nas outras quatro peças foi realizado um estudo angiografico, com injeçao de tinta nanquim e posterior diafanizaçao. Os metodos utilizados permitiram um melhor conhecimento da vascularizaçao parietal do colon sigmoide, mostrando a riqueza de sua distribuiçao que se faz em toda a superficie do colon, a partir da emergencia das arterias sigmoidianas no bordo mesenterico do orgao. Em conclusao, este trabalho experimental demonstrou a riqueza dos vasos parietais do colon sigmoide.

Anastomose intestinal asséptica: proposiçäo de uma nova técnica / Intestinal anastomosis aseptic: proposal of a new technic

Os autores, após revisäo da literatura sobre anastomose intestinal asséptica, desenvolveram projeto experimental em cäes propondo uma variante técnica no procedimento originariamente descrito, o que tornou possível seu uso sem as complicaçöes descritas em diversos trabalhos sobre o assunto. Os excelentes resultados observados nos cäes, corroborados pelo estudo radiológico e análise histopatológica, propiciaram seu uso rotineiro em nosso Serviço, tendo sido operados vinte e nove pacientes sem quaisquer complicaçöes pós-operatórias relacionadas con a sutura intestinal

Detecçäo de células circulantes expressando o gene HLM em paciente com neoplasia de sítio primário desconhecido: um relato de caso / Detection of circulating cells expressing HLM gene in an unknown primary site neoplasia: a case report

Introduçao: o gene HLM, um homólogo de proteína ligadora de oxisterol, foi recentemente descrito como um marcador potencial de disseminaçäo de tumores sólidos em sangue periférico de pacientes portadores de câncer. Objetivos: avaliar a expressäo do gene HLM, marcador de metástase, no sangue periférico de um paciente portador de neoplasia de sítio primário desconhecido. Material e método: RNA total foi extraído de 5ml de sangue periférico e avaliado para a expressäo do HLM, por RT-PCR. Resultados: foi observada expressäo do gene HLM em células de sangue periférico do paciente. Discussäo: nosso estudo foi centrado em I.S.S., 22 anos, masculino, que apresentou emagrecimento de mais de 5kg em um período de 15 dias, e apresentava, ao ultra-som abdominal, uma volumosa massa heterogênea de limites pouco definidos desde o apêndice xifóide até a pelve, com componentes intra e retroperitoneais. Laparotomia explorada revelou uma massa irressecável, de aspecto violáceo, sugestiva de hemangioma. Devido à possibilidade de sangramento maciço, näo foi feita biópsia da massa. Arteriografia de tronco celíaco, mesentéricas e cavografia afastaram a hipótese inicial de hemangioma. Marcadores tumorais rotineiramente usados em clínica foram negativos. Tomografia computadorizada de abdome, desta mesma época, näo esclarecia origem da massa. Em dois meses de evoluçäo, observou-se involuçäo totalmente espontânea da massa até atingir 5cm de diâmetro, localizando-se próxima à cauda do pâncreas. Como adenocarcinoma de pâncreas näo pode ser afastado (apesar de o paciente estar mostrando melhora de estado geral no período), o paciente continua em observaçäo ambulatorial. Conclusäo: análise molecular revelou expressäo do gene HLM, o que sugere fortemente que a massa seja maligna, embora tenha apresentado comportamento benigno clinicamente

Colostomia terminal asséptica

Os autores descrevem uma variante técnica de colostomia terminal onde o segmento intestinal exteriorizado é fixado a pele por meio de sutura entre a camada seromuscular e a derme após ser feita uma seromiotomia circunferencial. A extremidade intestinal é previamente fechada, evitando-se assim, contaminaçäo quando da exteriorizaçäo através da parede abdominal, sendo aberta 48 horas após a maturaçäo por meio de secçäo da mucosa a qual näo é incluída na sutura. Todos os casos nos quais esta técnica foi aplicada evoluiram sem infecçäo pericolostômica. Os resultados obtidos foram nitidamente superiores ao método clássico de maturaçäo precoce por sutura mucocutânea

Prevenção: o adolescente em cena / Prevention: the adolescent in scene

Esta publicação integra as atividades previstas pelo Projeto Institucional da REDE GAPA.