Articulação entre Práticas Integrativas e Promoção da Saúde: ações coletivas com acupuntura na Estratégia Saúde da Família / Articulation between Integrative Practices and Health Promotion: collective actions with acupuncture in the Family Health Strategy

As Práticas Integrativas e Complementares em Saúde (PICS) são reconhecidas pela Organização Mundial de Saúde e englobam várias terapêuticas corporais e comportamentais, sendo uma delas a acupuntura. Esta pesquisa teve como objetivo analisar uma experiência que articulou ações coletivas de acupuntura com a promoção da saúde em uma Unidade de Saúde da Família. Foi realizado um estudo descritivo e analítico, de natureza qualitativa, que utilizou rodas de conversas e registros em diário de pesquisa como estratégias para produção de dados. Este estudo possibilitou uma ampliação no acolhimento das demandas dos usuários, com estreitamento de vínculo entre a equipe de saúde e a comunidade, contribuindo para a desmedicalização do cuidado. Pôde-se perceber a ampliação da clínica,o aumento do conhecimento sobre as PICS, com incentivo à desmedicalização, autocuidado, participação de práticas coletivas, troca de saberes e inserção de estratégias capazes de colaborar com o processo de reconstrução de modos de viver a vida de pessoas que buscam o serviço de saúde.

Integrative and Complementary Practices in Health (PICS, in Portuguese) are recognizedby the World Health Organization and encompass several bodily and behavioral therapies, one of which is acupuncture. This research aimed to analyze and reflect on an experience that articulated collective actions using acupuncture practices with health promotion in a Family Health Unit. A descriptive and analytical study of qualitative nature was carried out, which used conversation circles and research diary records as strategies for data production. This study enabled an expansion in the understanding ofthe users' needs, with a closer bond between the health team and the community, contributing to the demedicalization of care. It was possible to perceive the expansion of the clinic's offer, the increase in knowledge of PICS, encouraging demedicalization,self-care, participation in collective practices, exchange of knowledge, and insertion of strategies capable of collaborating with the process of reconstructing the life habits of those who seek health care.

Desenvolvimento de um instrumento de avaliação para o método Pilates baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde / Development of an evaluation instrument for the Pilates method based on the International Classification of Functioning, Disability and Health

Há uma escassez em evidências científicas acerca de instrumentos de avaliação validados e padronizados aplicados ao Pilates. Diante da importância de uma análise individualizada e holística de cada paciente/cliente para melhor aplicação do método, faz-se necessário a construção de instrumentos que possuam uma abordagem biopsicossocial. Objetivo: Desenvolver um instrumento de avaliação para o Pilates, baseado na da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Métodos: A pesquisa foi realizada em quatro etapas. Levantamentos de informações sobre a avaliação no método Pilates, associação das informações com categorias da CIF, estudo Delphi, construção do instrumento. As informações foram obtidas por meio de um a scoping review e entrevistas com fisioterapeutas que trabalham com o Pilates, para construção as informações obtidas foram vinculadas com as categorias da CIF por dois pesquisadores de forma independente, em caso de discordância um terceiro julgaria a mais pertinente. Em seguida, foi realizado um estudo Delphi, para selecionar as categorias mais relevantes para compor o instrumento. Por fim, a construção do instrumento por três pesquisadores com conhecimento em Pilates e CIF. Resultados: O instrumento foi constituído por 49 categorias da CIF, distribuídas em 33 questões, sendo, 10 de funções do corpo, duas de estruturas do corpo, 16 de atividade e participação e, cinco dos fatores ambientais. Conclusão: O estudo possibilitou a construção de um instrumento que visa facilitar a compreensão do estado de saúde do paciente a partir de uma avaliação já realizada em cada serviço e, ao final será proporcionado uma linguagem comum.

There is a lack of scientific evidence on validated and standardized evaluation instruments applied to Pilates. Given the importance of an individualized and holistic analysis of each patient/client for a better application of the method, it is necessary to build instruments that have a bio-psychosocial approach. Objective: To develop an evaluation instrument for Pilates, based on the International Classification of Functioning, Disability and Health (ICF). Methods: The research was carried out in four stages. This is a survey of information about the assessment in the Pilates method, association of information with ICF categories, Delphi study, construction of the instrument. The information was obtained through a scoping review and interviews with physical therapists who work with Pilates. For the construction of the instrument, the information obtained was independently linked to the ICF categories by two researchers, and in case of disagreement a third party would judge the most pertinent. Next, a Delphi study was carried out to select the most relevant categories to compose the instrument; finally, the construction of the instrument by three researchers with knowledge about Pilates and ICF. Results: The instrument was made up of 49 ICF categories, distributed among 33 questions, being ten of body functions, two of body structures, 16 of activity and participation, and five of environmental factors. Conclusion: The study allowed the construction of an instrument that aims to facilitate the understanding of the patient's health status from an evaluation already performed in each service and, at the end, will provide a common language.

Natural deep eutectic solvents for sample preparation prior to elemental analysis by plasma-based techniques.

Natural deep eutectic solvents (NADES) based on xylitol, citric acid, and malic acid were synthesized and were then characterized using infrared spectroscopy, thermogravimetry (TG), differential scanning calorimetry (DSC), also density and viscosity were measurements. The deep eutectic solvents were used as solvent in ultrasound-assisted extraction (DES-UAE) of plant samples prior to elemental analysis. Inductively coupled plasma-mass spectrometry (ICP-MS) and inductively coupled plasma-optical emission spectrometry (ICP OES) were employed for the determination of As, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, P, and Zn in the extracts. The infrared analyses of the NADES revealed bands characteristic of the initial reagents, with the presence of hydrogen bonds, which confirmed the formation of a NADES. The thermal analyses showed decomposition temperatures of around 170 °C and endothermic events related to degradation of the NADES. The viscosity and density parameters were found to be related to the presence of hydrogen bonds. The extraction recoveries ranged from 80% to 120%, with some analytes presenting poor recoveries. There were no significant differences between the NADES, in terms of the concentrations of the analytes found in the extracts. However, there were differences between the analyte concentrations obtained using the NADES extraction method and the concentrations obtained using microwave-assisted acid digestion (MW-AD), possibly due to the different types of interactions between the solvents and the analytes. Plant tissues are complex matrices containing substantial amounts of silica, so some elements may be tightly bound and consequently difficult to release. The results indicated that UAE using NADES is a promising technique for the elemental extraction of plant samples.

A assistência dos enfermeiros aos pacientes com câncer em fase terminal: revisão integrativa / The assistance of nurses to patients with terminal cancer: integrative review / La asistencia de enfermería a pacientes con cáncer en etapa terminal: revisión integrativa

Objetivo: analisar a literatura científica sobre as dificuldades no processo de trabalho dos enfermeiros aospacientes com câncer em fase terminal e analisar as propostas de soluções para as dificuldades no processode trabalho dos enfermeiros aos pacientes com câncer em fase terminal. Método: revisão integrativa, combusca nas bases de dados BDENF e LILACS, no recorte temporal de 2010 a 2014. Para a análise dos dados,utilizou-se a modalidade temática da proposta da Análise de Conteúdo. Resultados: constatou-se, nodesenvolvimento do processo de trabalho dos enfermeiros, o despreparo emocional, psicológico e técnico naárea da oncologia paliativa oriundo da formação e da ausência de investimento institucional nos profissionais.Conclusão: fundamental uma mudança na formação, proporcionando aos enfermeiros uma base mais sólidapara atuarem na oncologia paliativa e interesse institucional na capacitação e apoio psicológico aos seus funcionários.(AU)

Objective: to analyze in the scientific literature on the difficulties in the work process of nurses to patients with final stage cancer and to analyze the proposed solutions for the difficulties in the work process of the nurses to the patients with final stage cancer. Method: integrative review, with search in the databases BDENF and LILACS, in the time cut from 2010 to 2014. For the analysis of the data, the thematic modality of the Content Analysis proposal was used. Results: the development of the nurses' work process, the emotional, psychological and technical lack of preparation in the area of palliative oncology, came from the formation and lack of institutional investment for professionals was observed. Conclusion: a change in training is fundamental, providing nurses with a more solid base to work in palliative oncology and institutional interest in training and psychological support to their employees.(AU)

Objetivo: analizar la literatura científica acerca de las dificultades en el proceso de trabajo del personal de enfermería a pacientes con cáncer terminal y analizar propuestas de soluciones a las dificultades en el proceso de trabajo del personal de enfermería a pacientes con cáncer terminal. Método: revisión Integrativa, con búsqueda en las bases de datos BDENF y LILACS, en el período de 2010 a 2014. Para el análisis de datos, modo temático fue utilizado la modalidad temática de propuesta de análisis del contenido. Resultados: se encontró en el desarrollo del proceso de trabajo de enfermeras, la falta de preparo emocional, psicológico y técnico en el área de Oncología paliativa, de formación y la ausencia de inversión institucional a los profesionales. Conclusión: fundamental un cambio en la formación, proporcionando los enfermeros una base más sólida para actuaren en oncología paliativa y de interés institucional en apoyo psicológico y capacitación a sus empleados.(AU)

Opinião dos pacientes com câncer em fase terminal sobre a assistência dos enfermeiros: revisão integrativa / Opinion of terminal cancer patients on nursing assistance: integrative review / Opinión de pacientes con cáncer terminal sobre la asistencia del personal de enfermería: revisión integrativa

Objetivo: analisar, nas publicações científicas, a opinião dos pacientes com câncer em fase terminal acercada assistência pelos enfermeiros. Método: revisão integrativa, com busca nas bases de dados BDENF e LILACS,no intuito de responder à seguinte questão da pesquisa: Qual a opinião dos pacientes com câncer em faseterminal nas publicações científicas acerca da assistência prestada pelos enfermeiros? Para a análise dosdados, utilizou-se a modalidade temática da proposta da análise de conteúdo. Resultados: constata-se que aassistência dos enfermeiros é pautada no controle dos sintomas e suporte físico, não sendo estabelecido osuporte emocional necessário. Conclusão: com relação à visão dos pacientes em relação à assistência dosenfermeiros, nenhum artigo abordou a questão, onde se conclui que são necessários mais estudos em relaçãoà visão destes pacientes acerca da assistência recebida, servindo de feed-back, pois redundará em umenriquecimento da assistência prestada.(AU)

Objective: to analyze, in the scientific publications, the opinion of the patients with cancer in the terminal phase about the care given by the nurses. Method: integrative review, with a search in the BDENF and LILACS databases, in order to answer the following research question: What is the opinion of patients in final stage cancer in scientific publications about the care provided by nurses? For the analysis of the data, the thematic modality of the content analysis proposal was used. Results: nurses' care is based on the control of symptoms and physical support, and the necessary emotional support was not established. Conclusion: regarding patients' views regarding nurses' care, no article addressed the issue, which concludes that more studies are needed regarding the patients' vision about the care received, as a feed-back, as it will an enrichment of the assistance provided.(AU)

Objetivo: analizar en las publicaciones científicas la opinión de los pacientes con cáncer terminal sobre la asistencia por enfermeros. Método: revisión Integrativa, con búsqueda en las bases de datos BDENF y LILAS y con el fin de responder la siguiente pregunta: ¿Qué es la encuesta de opinión de los pacientes con cáncer terminal en las publicaciones científicas sobre la asistencia prestada por los enfermeros? Para el análisis de datos, se utilizó la modalidad temático de propuesta de análisis del contenido. Resultados: observó que la atención de los enfermeros se basa en el control de síntomas y de soporte físico, no estableciendo el apoyo emocional necesario. Conclusión: con respecto a la visión de los pacientes en relación con la asistencia de enfermeros, ningún artículo ha sido abordada la cuestión, se concluye que es necesario estudios adicionales en relación con la visión de estos pacientes sobre la asistencia recibida, que sirve de feed-back, porque redundan al enriquecimiento de la asistencia.(AU)

Eficácia do Epi-No® na diminuição da episiotomia e risco de lesão perineal pós-parto: revisão sistemática / Effectiveness of Epi-No® in decline episiotomy and risk of injury perineal postpartum: systematic review

A pergunta mais clássica das gestantes ou futuras mães seria qual tipo de parto escolher. Para as que pretendem ter parto normal, o desejo é ter seu períneo íntegro após o parto. Como a taxa de episiotomia aumentou consideravelmente, e atualmente é a operação cirúrgica mais frequente em mulheres no mundo, surge à necessidade de pesquisar quais métodos seriam capazes de minimizar ou evitar esse procedimento. Este estudo objetivou avaliar a eficácia de um aparelho em forma de balão que infla com ajuda de um medidor de pressão denominado Epi-No® na redução da necessidade de episiotomia e na diminuição do risco de lesão pós-parto. Foi realizada uma revisão sistemática da literatura, de estudos clínicos randomizados, que investigassem os efeitos do Epi-No® levantados no período de 24 a 30 de setembro de 2014 através das palavras-chave. Inicialmente foram encontrados 1.149 artigos, seguindo os critérios de inclusão e exclusão, o número foi reduzido, sendo analisados 6 artigos neste estudo. Conclui-se então que o uso do Epi-No® parece ser eficaz na redução de episiotomia e lesões pós-parto, no entanto são necessários mais estudos controlados randomizados com maiores números amostrais para determinar melhor a sua eficácia.(AU)

The most classic question of pregnant women or future mothers is: which type of delivery to choose? For those who intend to take normal delivery, the desire is that the perineum remain integrate after delivery. Since episiotomy rate has increased considerably and is currently the most common surgical procedure in women in the world, comes the need to know which methods would be effective to prevent it. This study aimed to evaluate the effectiveness of a balloon-like device that inflates with the help of a pressure gauge known as Epi-No® in reducing the need for episiotomy and decreased risk of postpartum injury. A systematic literature review was performed with randomized clinical trials to investigate the effects of Epi-No®, from September 24 to 30, using keywords. Initially, were found 1.149 articles, following the inclusion and exclusion criteria, the number was reduced and 6 articles wer analyzed in this study. The conclusion is that Epi-No® appears to be effective in reducing episiotomy and postpartum injuries, but we need more randomized controlled trials with larger sample numbers to better determine their effectiveness.(AU)

Effects of treating old rats with an aqueous Agaricus blazei extract on oxidative and functional parameters of the brain tissue and brain mitochondria.

Dysfunction of the mitochondrial respiratory chain and increased oxidative stress is a striking phenomenon in the brain of aged individuals. For this reason there has been a constant search for drugs and natural products able to prevent or at least to mitigate these problems. In the present study the effects of an aqueous extract of Agaricus blazei, a medicinal mushroom, on the oxidative state and on the functionality of mitochondria from the brain of old rats (21 months) were conducted. The extract was administered intragastrically during 21 days at doses of 200 mg/kg. The administration of the A. blazei extract was protective to the brain of old rats against oxidative stress by decreasing the lipid peroxidation levels and the reactive oxygen species content and by increasing the nonenzymic and enzymic antioxidant capacities. Administration of the A. blazei extract also increased the activity of several mitochondrial respiratory enzymes and, depending on the substrate, the mitochondrial coupled respiration.

The action of p-synephrine on hepatic carbohydrate metabolism and respiration occurs via both Ca(2+)-mobilization and cAMP production.

Citrus aurantium extracts, which contain large amounts of p-synephrine, are widely used for weight loss purposes and as appetite suppressants. In the liver, C. aurantium (bitter orange) extracts affect hemodynamics, carbohydrate metabolism, and oxygen uptake. The purpose of the present work was to quantify the action of p-synephrine and also to obtain indications about its mechanism of action, a task that would be difficult to accomplish with C. aurantium extracts due to their rather complex composition. The experimental system was the isolated perfused rat liver. p-Synephrine significantly stimulated glycogenolysis, glycolysis, gluconeogenesis, and oxygen uptake. The compound also increased the portal perfusion pressure and the redox state of the cytosolic NAD(+)/NADH couple. A Ca(2+)-dependency for both the hemodynamic and the metabolic effects of p-synephrine was found. p-Synephrine stimulated both cAMP overflow and the initial Ca(2+) release from the cellular stores previously labeled with (45)Ca(2+). The metabolic and hemodynamic actions of p-synephrine were strongly inhibited by α-adrenergic antagonists and moderately affected by ß-adrenergic antagonists. The results allow to conclude that p-synephrine presents important metabolic and hemodynamic effects in the liver. These effects can be considered as both catabolic (glycogenolysis) and anabolic (gluconeogenesis), they are mediated by both α- and ß-adrenergic signaling, require the simultaneous participation of both Ca(2+) and cAMP, and could be contributing to the overall stimulation of metabolism that usually occurs during weight loss periods.

Harmful effects of usnic acid on hepatic metabolism.

Usnic acid is a naturally occurring dibenzofuran derivative found in several lichen species. The compound has been marketed as an ingredient of food supplements for weight reduction. There is evidence that the compound acts as an uncoupler of mitochondrial oxidative phosphorylation and it is also clear that consumption of the drug can lead to severe hepatotoxicity depending on the doses. Based on these and other ideas the objective of the present work was to investigate the possible effects of usnic acid on liver metabolism. Livers of male Wistar rats were perfused in a non-recirculating system. Usnic acid stimulated oxygen consumption at low concentrations, diminished the cellular ATP levels, increased the cytosolic but diminished the mitochondrial NADH/NAD(+) ratio, strongly inhibited gluconeogenesis from three different substrates (IC(50) between 1.33 and 3.61 µM), stimulated glycolysis, fructolysis, glycogenolysis and ammoniagenesis and inhibited ureogenesis. The (14)CO(2) production from [1-(14)C]octanoate and [1-(14)C]oleate was increased by usnic acid, but ketogenesis from octanoate was diminished and that from oleate was not affected. It may be concluded that the effects of usnic acid up to 2.5 µM reflect predominantly its activity as an uncoupler. At higher concentrations, however, several other effects may become significant, including inhibition of mitochondrial electron flow and inhibition of medium-chain fatty acid oxidation. In metabolic terms, toxicity of usnic acid can be predicted to be especially dangerous in the fasted state due to the combination of several deleterius events such as diminished hepatic glucose and ketone bodies output to the brain and increased ammonia production.

Evaluation of the efficacy of flaxseed meal and flaxseed extract in reducing menopausal symptoms.

The objective of this study was to evaluate the efficacy of flaxseed meal and flaxseed extract in reducing climacteric symptoms of menopausal women. Ninety menopausal women were randomly distributed into three study groups: group I received 1 g per day of flaxseed extract containing at least 100 mg of secoisolariciresinol diglucoside (SDG), group II received 90 g per day of flaxseed meal containing at least 270 mg of SDG, and group III received 1 g per day of collagen (placebo group). Subjects were assessed for menopausal symptoms by the Kupperman index at the beginning and at the end of the 6 months of treatment. Subjects were also assessed for endometrial thickness and vaginal cytology. The Kupperman index values at the beginning and end of the treatments were analyzed using the paired t-test. Both the flaxseed extract (P=.007) and the flaxseed meal (P=.005) were effective in reducing the menopausal symptoms when compared with the placebo control (P=.082). Alternatively, the changes in Kupperman index were also computed and submitted to analysis of variance. In this case, no significant differences were found (P=.084) although the data indicate a decreasing tendency for the Kupperman index by both the flaxseed extract and the flaxseed meal groups. Neither the flaxseed extract nor the flaxseed meal exerted clinically important estrogenic effects on the vaginal epithelium or endometrium as revealed by the absence of changes in the blood levels of follicle stimulating hormone and estradiol, as well as in the endometrial thickness, and vaginal epithelial maturation value. No serious adverse events related to the treatments were reported. Although the results of the present study do not allow an unequivocal conclusion about the action of flaxseed on the menopausal symptoms, they suggest that it could be premature to conclude that no such action exists. Clearly the matter still deserves further experimental attention.

Effects of Citrus aurantium (bitter orange) fruit extracts and p-synephrine on metabolic fluxes in the rat liver.

The fruit extracts of Citrus aurantium (bitter orange) are traditionally used as weight-loss products and as appetite supressants. An important fruit component is p-synephrine, which is structurally similar to the adrenergic agents. Weight-loss and adrenergic actions are always related to metabolic changes and this work was designed to investigate a possible action of the C. aurantium extract on liver metabolism. The isolated perfused rat liver was used to measure catabolic and anabolic pathways, including oxygen uptake and perfusion pressure. The C. aurantium extract and p-synephrine increased glycogenolysis, glycolysis, oxygen uptake and perfusion pressure. These changes were partly sensitive to α- and ß-adrenergic antagonists. p-Synephrine (200 µM) produced an increase in glucose output that was only 15% smaller than the increment caused by the extract containing 196 µM p-synephrine. At low concentrations the C. aurantium extract tended to increase gluconeogenesis, but at high concentrations it was inhibitory, opposite to what happened with p-synephrine. The action of the C. aurantium extract on liver metabolism is similar to the well known actions of adrenergic agents and can be partly attributed to its content in p-synephrine. Many of these actions are catabolic and compatible with the weight-loss effects usually attributed to C. aurantium.

[Effect of length of exclusive breastfeeding and mixed feeding on hemoglobin levels in the first six months of life: a follow-up study]. / Efeito da duração da amamentação exclusiva e mista sobre os níveis de hemoglobina nos primeiros seis meses de vida: um estudo de seguimento.

This six-month follow-up study aimed to assessing the effect of length of both exclusive breastfeeding and mixed feeding on hemoglobin levels in 150 infants born at the Mutuípe maternity facility in Bahia State, Brazil. Blood tests were performed monthly to assess the hemoglobin levels, at which time data were gathered on food intake. Obstetric and socioeconomic data were also collected. The linear mixed effects model was used to investigate the target associations. Loss to follow-up was 15.3%, and anemia prevalence was 71.7%. An increase of 0.091 g/dL (p = 0.031) in hemoglobin levels was found for each month of exclusive breastfeeding, while a decrease of 0.097 g/dL (p = 0.017) was shown for each month of mixed feeding. In conclusion, inadequate food practices appear to be directly involved in the etiology of iron deficiency anemia during infancy.

Efeito da duração da amamentação exclusiva e mista sobre os níveis de hemoglobina nos primeiros seis meses de vida: um estudo de seguimento / Effect of length of exclusive breastfeeding and mixed feeding on hemoglobin levels in the first six months of life: a follow-up study

O objetivo deste estudo foi avaliar o efeito da duração da amamentação exclusiva e mista sobre os níveis de hemoglobina de lactentes. Trata-se de um estudo de seguimento com seis meses de duração, envolvendo 150 crianças nascidas na maternidade de Mutuípe, Bahia, Brasil. Mensalmente, as crianças eram submetidas ao exame de sangue para avaliação dos níveis de hemoglobina e realizava-se coleta de dados de consumo alimentar. Foram obtidos, ainda, dados obstétricos e sócio-econômicos. Utilizou-se o modelo linear de efeitos mistos para investigar as associações de interesse. Ao final do seguimento, a perda amostral foi de 15,3 por cento, e detectou-se uma prevalência de 71,7 por cento de anemia. Constatou-se um incremento de 0,091g/dL nos níveis de hemoglobina a cada mês de duração de aleitamento materno exclusivo (p = 0,031), enquanto, a cada mês de duração de aleitamento materno misto, os níveis de hemoglobina declinaram em 0,097g/dL (p = 0,017). Concluiu-se que as práticas alimentares inadequadas parecem estar diretamente envolvidas na etiologia da deficiência nutricional de ferro nesse período da vida.

This six-month follow-up study aimed to assessing the effect of length of both exclusive breastfeeding and mixed feeding on hemoglobin levels in 150 infants born at the Mutuípe maternity facility in Bahia State, Brazil. Blood tests were performed monthly to assess the hemoglobin levels, at which time data were gathered on food intake. Obstetric and socioeconomic data were also collected. The linear mixed effects model was used to investigate the target associations. Loss to follow-up was 15.3 percent, and anemia prevalence was 71.7 percent. An increase of 0.091g/dL (p = 0.031) in hemoglobin levels was found for each month of exclusive breastfeeding, while a decrease of 0.097g/dL (p = 0.017) was shown for each month of mixed feeding. In conclusion, inadequate food practices appear to be directly involved in the etiology of iron deficiency anemia during infancy.

Cisto de desenvolvimento pré-sacro: relato de um caso e revisäo da literatura / Presacral developmental cyst: case report and review of the literature

Tumores do espaço retrorretal säo muito raros em adultos, sendo frequentemente diagnosticados erradamente e tratados inadequadamente. Os autores apresentam um caso de cisto dermóide, uma das três modalidades de cisto de desenvolvimento pré-sacros, diagnosticado em uma paciente do sexo feminino, branca, casada, sem filhos, com 40 anos de idade. Foi ela submetida, antes de 18 anos de idade, a três abordagens cirúrgicas com diagnóstico de doença pilonidal sacrococcigeneana: drenagem de abscesso, ressecçäo da doença por técnica fechada e por técnica aberta. O exame físico, o exame proctológico, o enema opaco, a fistulografia com cistografia, associados à tomografia computadorizada de pelve nos planos axial, sagital e coronal, permitiram o perfeito diagnóstico de um grande tumor cístico localizado no espaço pré-sacro. O tumor foi abordado cirurgicamente, usando-se a via de acesso de Kraske, tendo sido removido sem lesäo às paredes retais. A atençäo dos autores foi chamada pela extrema raridade destes tumores em adultos, levando-nos à apresentaçäo do caso e à revisäo da literatura, particularmente no que diz respeito à sua incidência, classificaçäo, natureza, patogenia, histopatologia, diagnóstico e abordagem cirúrgica