ABSTRACT
Para prevenir e resolver situações de desmotivação e stresse profissional em profissionais de Educação e de Saúde foi formulado um Programa de Formação Contínua. A versão revista do Programa tem a duração de 50h, distribuídas em onze sessões, dez em sala, centradas nos seguintes aspectos: partilha de experiências profissionais com colegas, identificação de fatores de stresse e estratégias de coping para lidar com eles, substituir crenças irracionais por crenças mais apropriadas, treinar competências de assertividade e de relaxamento. No final, integra um dia de formação no exterior, fora de aula. Comparando os resultados obtidos antes e depois do Programa de Formação, os participantes revelam um aumento significativo da percepção de bem-estar profissional (AU)
ABSTRACT
We describe two patients with severe, isolated, congenital dysphagia caused by paralysis of the pharyngeal muscles, who recovered at the ages of 40 months and 20 months, respectively. No other evidence of neurologic or muscular dysfunction was present except for a transient paralysis of the adductors of the vocal cords in one child. Radiocinematographic studies showed paralysis of the pharyngeal stage of swallowing, with minimal involvement of the oral stage. One child refused oral feeding for several months after apparent radiologic recovery. Two other patients with a similar disorder died of tracheal aspiration at the ages of 8 months and 4 months, respectively. Autopsies showed no abnormality of the central nervous system, and the cranial nerves involved in swallowing were normal. Only five other well-studied cases of this syndrome have been reported. These observations demonstrate the existence of a type of severe, idiopathic, congenital dysphagia related to paralysis of the constrictor muscles of the pharynx, with a propensity to recover after several months or years if properly managed. The cause of the disorder is obscure, but it is probably related to a dysfunction of the central nervous system.
Subject(s)
Deglutition Disorders/etiology , Pharyngeal Diseases/congenital , Pharyngeal Diseases/complications , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Paralysis/complicationsABSTRACT
Stenosis of the suprahepatic inferior vena caval anastomosis is a rare but serious vascular complication after liver transplantation. It may cause significant obstruction to venous drainage from the allograft liver and result in the Budd-Chiari syndrome with massive ascites and pleural effusion causing respiratory compromise. The authors report two such cases in which percutaneous transluminal angioplasty (PTA) of the stenotic anastomosis was performed. This nonsurgical approach resulted in resolution of ascites, pleural effusion, and respiratory distress in both patients. They conclude that PTA is a therapeutic alternative with minimal risk compared with surgical repair or retransplantation and should be considered the initial treatment of choice in selected patients.