Primary umbilical endometriosis.

OBJECTIVE: to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis. METHODS: an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence. RESULTS: six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period. CONCLUSION: umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

Primary umbilical endometriosis / Endometriose umbilical primária

ABSTRACT Objective: to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis. Methods: an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence. Results: six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period. Conclusion: umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

RESUMO Objetivo: relatar as características, evolução e desfecho de pacientes portadoras de endometriose umbilical primária. Métodos: estudo observacional e descritivo de pacientes portadoras de endometriose umbilical primária diagnosticada entre 2014 e 2017. As variáveis clínicas avaliadas foram: idade, quadro clínico, características das lesões, métodos diagnósticos, tratamento e recidiva. Resultados: seis pacientes com diagnóstico de endometriose umbilical primária, com idades entre 28 e 45 anos foram operadas no período do estudo. Elas apresentavam lesões que variavam de 1,0cm a 2,5cm de diâmetro, de cor violácea em cinco pacientes e eritemato-violácea em uma. O tempo de duração dos sintomas até o diagnóstico variou de um a três anos e em todos os casos estudados o diagnóstico foi feito por meio das manifestações clínicas e confirmado por meio da análise histopatológica. Nenhum caso foi associado com alterações neoplásicas. Todas as pacientes avaliadas apresentavam como manifestação clínica dor e sangramento umbilical no período menstrual. Conclusão: a endometriose umbilical é uma doença pouco frequente e deve ser incluída no diagnostico diferencial de mulheres como nódulo umbilical. O tratamento de eleição é a exérese total da lesão.

Inguinodynia in patients submitted to conventional inguinal hernioplasty.

Objective: to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. Methods: this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. Results: out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. Conclusion: the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature.

Objetivo: avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. Métodos: trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. Resultados: do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. Conclusão: observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

Inguinodynia in patients submitted to conventional inguinal hernioplasty / Inguinodinia em pacientes submetidos à hernioplastia inguinal convencional

ABSTRACT Objective : to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. Methods : this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. Results : out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. Conclusion : the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature.

RESUMO Objetivo: avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. Métodos: trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. Resultados: do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. Conclusão: observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

Percepção de dispneia em repouso e em atividades físicas habituais em diferentes graus de obesidade / Perception of dyspnea at rest and in daily physical activities in varying degrees of obesity

JUSTIFICATIVA E OBJETIVO: Dispneia é uma experiência subjetiva de desconforto respiratório, cujos mecanismos fisiopatológicos e de percepção são complexos. O objetivo deste estudo foi avaliar a percepção de dispneia dos obesos em repouso e em atividades físicas habituais, utilizando três escalas de dispneia, e verificar a influência do peso corporal na percepção de dispneia crônica. MÉTODOS: Estudo transversal, incluindo 140 pacientes com peso normal e sobrepeso (grupo controle) e obesidade graus I, II e III, que foram subdivididos em seis subgrupos. Dispneia crônica foi avaliada utilizando-se descritores de dispneia e percepção de dispneia em repouso e em atividades físicas habituais por meio três escalas de dispneia: Escala Analógica Visual, Escala de Diagrama de Custo de Oxigênio e Medical Research Council modificada. RESULTADOS: Os grupos tiveram distribuição homogênea quanto a gênero, idade, cor da pele, altura, status tabágico e atividade física. O peso corporal médio foi 109,5±30,9kg e o índice de massa corporal de 39,91±10,57kg/m², com diferenças significativas entre os grupos (p<0,001). Nenhum dos pacientes referiu dispneia em repouso em posição sentada, nas três escalas utilizadas. Houve diferenças significativas entre os grupos quanto à percepção de dispneia em atividades físicas habituais, que se intensificaram nos grupos com o índice de massa corporal mais elevada (p<0,0001). CONCLUSÃO: Indivíduos obesos livres de comorbidades que influenciam a percepção de dispneia não demonstram dispneia em repouso; todavia, apresentaram dispneia crônica em atividades físicas habituais da vida diária, que sofre influência do aumento progressivo do peso corporal...

BACKGROUND AND OBJECTIVE: Dyspnea is a subjective experience respiratory distress whose pathophysiological mechanisms and perception are complex. The objective of this study was to evaluate the perception of dyspnea in obese at rest and in habitual physical activities, using three scales of dyspnea, and check the influence of body weight on the perception of chronic dyspnea. METHDOS: Cross-sectional study including 140 patients with normal weight and overweight (control group) and obesity grades I, II and III, which were subdivided into six subgroups. Chronic dyspnea was assessed using descriptors of dyspnea and perception of dyspnea at rest and in daily physical activities through three dyspnea scales: Visual Analog Scale, Oxygen Cost Diagram scale and modified Medical Research Council. RESULTS: The groups were homogeneous distributed according to gender, age, skin color, height, smoking status and physical activity. The average body weight was 109.5±30.9kg and body mass index 39.91±10.57kg/m², with significant differences between groups (p<0.001). None of the patients reported dyspnea at rest in a sitting position according to the three scales used. There were significant differences between the groups regarding the perception of dyspnea in daily physical activities, which were intensified in the groups with higher body mass index (p<0.0001). CONCLUSION: Obese individuals with no comorbidities which can influence the perception of dyspnea had no dyspnea at rest; however, they presented with chronic dyspnea in daily physical activities of daily living, influenced by the progressive increase in body weight...

Descritores de dispnéia e percepção de dispnéia crônica nos variados graus de obesidade / Descriptors of dyspnea and perception of dyspnea in varying levels of obesity

JUSTIFICATIVA E OBJETIVO: Embora frequente e importante na prática médica, estudar dispneia permanece um desafio. Os objetivos deste estudo foram verificar os principais descritores de dispneia mencionados por obesos utilizando-os na determinação da percepção de dispneia crônica em diferentes graus de obesidade, e avaliar a influência do excesso de peso. MÉTODOS: Estudo transversal, incluindo 140 pacientes com peso normal e sobrepeso (Grupo Controle) e obesidade graus I, II e III, que foram subdivididos em seis subgrupos. A dispneia crônica foi avaliada utilizando-se os principais descritores de dispneia, na amostra geral e nos subgrupos de obesos. RESULTADOS: A percepção de dispneia na amostra total estudada foi de 57,1% (IC95%: 48,5-65,5) e em cada subgrupo foi: Grupo I: 3,8% (IC95%: 0,1-19,6); Grupo II: 33,3% (IC95%:13,3-59,0); Grupo III: 62,5% (IC95%: 40,6-81,2); Grupo IV: 86,7% (IC95%: 69,3-96,2); Grupo V: 65,2% (IC95%: 42,7-83,6); e Grupo VI: 89,5% (IC95%: 66,9-98,7). Os principais descritores de dispneia foram cansaço no peito (58,7%), fôlego curto (47,5%), dificuldade de respirar (36,2%), falta de ar (31,2%) e respiração rápida (17,5%), com diferenças significativas entre os grupos (p<0,0001 e p<0,002, respectivamente). CONCLUSÃO: Observou-se elevada prevalência da percepção de dispneia em todos os graus de obesidade, com aumentos progressivos à medida que se elevou o índice de massa corporal, principalmente em obesos mórbidos. A utilização dos descritores de dispneia na investigação de dispneia crônica em obesos é útil, e os principais descritores de dispneia relatados foram cansaço no peito, fôlego curto e dificuldade de respirar...

BACKGROUND AND OBJECTIVE: Despiteits frequency and importance in medical practice, the study of dyspnea remains a challenge. The objective of this study was to verify the main descriptors of dyspnea mentioned by the obese, and use them to determine the perception of chronic dyspnea in varying levels of obesity, and to evaluate the influence of excess weight. METHODS: Cross-sectional study including 140 patients with normal weight and overweight (control group) and obesity grades I, II and III, who were subdivided into six subgroups. Chronic dyspnea was evaluated using the main descriptors of dyspnea in the overall sample and in the subgroups of the obese. RESULTS: The perception of dyspnea in the total sample studied was 57.1% (95%CI: 48.5-65.5); and in each group was: Group I: 3.8% (95%CI: 0.1-19, 6); GroupII: 33.3% (95%CI: 13.3-59.0); Group III: 62.5% (95% CI:40.6-81.2); Group IV: 86.7% (95% CI: 69.3-96.2); Group V:65.2% (95%CI: 42.7-83.6); Group VI: 89.5% (95%CI: 66.9-98.7). The main descriptors of dyspnea were chest tiredness (58.7%), shortness of breath (47.5%), difficulty to breathe (36.2%), breathlessness (31.2%), rapid breathing (17.5%), with significant differences between groups (p<0.0001 and p<0.002, respectively). CONCLUSION: We observed a high prevalence of perception of dyspnea in all levels of obesity, with progressive increases as body mass index rises - especially in morbidly obese patients. The use of descriptors of dyspnea in the investigation of chronic dyspnea in obese individuals is useful, and the main descriptors of dyspnea were chest tiredness, shortness of breathand difficulty to breathe...

Influence of respiratory muscle strength in evolution of patients with heart failure after cardiac surgery.

OBJECTIVE: To investigate the influence of preoperative respiratory muscle strength in postoperative pulmonary complications in patients with heart failure undergoing cardiac surgery. METHODS: From March 2009 to September 2010, 40 patients admitted to the cardiology service of the Fundação de Beneficência Hospital de Cirurgia were divided into two groups according to the values of maximal inspiratory pressure measured by manometer: Group A (n = 21), composed of patients with normal respiratory muscle strength, and Group B (n = 19), patients with reduced strength. After pre-operative evaluation, all patients underwent the surgical procedure and followed until hospital discharge by the same researcher, who recorded on data collection especially its evolution for the presence of pulmonary complications after surgery, which was divided general and specific. RESULTS: 19% of patients in group A and 31.6% of patients in group B had pulmonary complications overall, this difference was not statistically significant (P = 0.29). Regarding the presence of specific complications, group A was 14.3% and 10.5% group B (P = 0.55). There was also no difference in the days of ICU stay and total (ICU + ward) between groups. CONCLUSION: In this study, preoperative respiratory muscle dysfunction does not seem to influence the evolution of heart failure patients for the presence of pulmonary complications after cardiac surgery.

Effects of progressive increase in body weight on lung function in six groups of body mass index.

OBJECTIVE: To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS: Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS: Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p < 0.001), forced vital capacity (FVC) (p < 0.002, p < 0.02) and forced expiratory volume in one second (FEV1) (p < 0.001, p < 0.03) in relative and absolute values, respectively. Group VI (BMI > 50.9 kg/m²) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m²) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION: Lung function is influenced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m²; these changes are more evident when BMI > 50.9 kg/m².

Efeitos do aumento progressivo do peso corporal na função pulmonar em seis grupos de índice de massa corpórea / Effects of progressive increase in body weight on lung function in six groups of body mass index

OBJETIVO: Avaliar os efeitos do aumento progressivo do peso corpóreo na função pulmonar através da saturação periférica de oxigênio, espirometria e pressões respiratórias máximas em diferentes graus de obesidade. MÉTODOS: Estudo transversal, incluindo 140 pacientes em avaliação clínica e cirúrgica para tratamento de obesidade. Os pacientes selecionados foram divididos em seis grupos de índice de massa corpórea (IMC), incluindo um grupo-controle de não obesos e a subdivisão dos obesos mórbidos em três subgrupos. RESULTADOS: Foram demonstradas diferenças significativas entre os grupos na saturação periférica de oxigênio (SpO2) (p < 0,001), capacidade vital forçada (CVF) (p < 0,002; p < 0,02) e volume expiratório forçado no primeiro segundo (VEF1) (p < 0,001; p < 0,03), em valores relativos e absolutos, respectivamente. O grupo VI (IMC > 50,9 kg/m²) demonstrou diferenças significativas (SpO2, CVF e VEF1) em relação aos demais grupos (exceto grupo V) e o grupo V (IMC > 45 a 49,9 kg/m²) em relação ao grupo-controle. As demais variáveis (razão VEF1/CVF, fluxo expiratório forçado 25-75 [FEF25-75] e pressões respiratórias máximas) não apresentaram diferenças estatísticas. CONCLUSÃO: A função pulmonar sofre influência do aumento progressivo do IMC, com as alterações funcionais respiratórias sendo mais bem demonstradas com o IMC > 45 kg/m² e ficando bem mais acentuadas quando o IMC excede a 50,9 kg/m².

OBJECTIVE: To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS: Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS: Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p < 0.001), forced vital capacity (FVC) (p < 0.002, p < 0.02) and forced expiratory volume in one second (FEV1) (p < 0.001, p < 0.03) in relative and absolute values, respectively. Group VI (BMI > 50.9 kg/m²) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m²) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION: Lung function is influen- ced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m²; these changes are more evident when BMI > 50.9 kg/m².

Influência da força muscular respiratória na evolução de pacientes com insuficiência cardíaca após cirurgia cardíaca / Influence of respiratory muscle strength in evolution of patients with heart failure after cardiac surgery

OBJETIVOS: Verificar a influência da força muscular respiratória pré-operatória na incidência de complicações pulmonares no pós-operatório de cirurgia cardíaca em pacientes com insuficiência cardíaca. MÉTODOS: De março de 2009 a setembro de 2010, 40 pacientes internados no serviço de cardiologia da Fundação de Beneficência Hospital de Cirurgia foram distribuídos em dois grupos, de acordo com os valores da pressão inspiratória máxima avaliada por meio da manovacuometria: Grupo A (n=21), composto de pacientes que apresentaram força muscular respiratória normal; e grupo B (n=19), pacientes com redução da força. Após a avaliação pré operatória, todos foram submetidos ao procedimento cirúrgico e acompanhados até o momento da alta hospitalar pelo mesmo pesquisador, que anotava na ficha de coleta de dados sua evolução, especialmente quanto à presença de complicações pulmonares no pós-operatório, que foi dividida em geral e específica. RESULTADOS: Dezenove por cento dos pacientes do grupo A e 31,6% dos pacientes do grupo B apresentaram complicações pulmonares gerais, sendo esta diferença não significativa estatisticamente (P=0,29). Quanto à presença de complicações específicas, o grupo A teve 14,3% e o grupo B 10,5% (P= 0,55). Também não houve diferença quanto aos dias de internação em UTI e total (UTI + enfermaria) entre os grupos. CONCLUSÃO: Nesse trabalho, a disfunção muscular respiratória no pré-operatório de cirurgia cardíaca não foi considerada um fator de risco para desenvolvimento de complicações pulmonares no pós-operatório.

OBJECTIVE: To investigate the influence of preoperative respiratory muscle strength in postoperative pulmonary complications in patients with heart failure undergoing cardiac surgery. METHODS: From March 2009 to September 2010, 40 patients admitted to the cardiology service of the Fundação de Beneficência Hospital de Cirurgia were divided into two groups according to the values of maximal inspiratory pressure measured by manometer: Group A (n = 21), composed of patients with normal respiratory muscle strength, and Group B (n = 19), patients with reduced strength. After pre-operative evaluation, all patients underwent the surgical procedure and followed until hospital discharge by the same researcher, who recorded on data collection especially its evolution for the presence of pulmonary complications after surgery, which was divided general and specific. RESULTS: 19% of patients in group A and 31.6% of patients in group B had pulmonary complications overall, this difference was not statistically significant (P = 0.29). Regarding the presence of specific complications, group A was 14.3% and 10.5% group B (P = 0.55). There was also no difference in the days of ICU stay and total (ICU + ward) between groups. CONCLUSION: In this study, preoperative respiratory muscle dysfunction does not seem to influence the evolution of heart failure patients for the presence of pulmonary complications after cardiac surgery.

Prevalence and severity of asthma in obese adult candidates for bariatric surgery.

OBJECTIVE: To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS: This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m²) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS: The prevalence of asthma in the obese population studied was 18.5% (95% CI: 14.5-22.4). That prevalence was 20.4% (95% CI: 16.2-24.5) and 13.7% (95% CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0% (95% CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4% (95% CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3%), mild persistent asthma in 7 (10.4%), moderate asthma in 25 patients (37.3%), and severe persistent asthma in 6 (9.0%). CONCLUSIONS: Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominated.

Prevalência e gravidade de asma brônquica em adultos obesos com indicação de cirurgia bariátrica / Prevalence and severity of asthma in obese adult candidates for bariatric surgery

OBJETIVO: Determinar a prevalência de asma em um grupo de adultos obesos, candidatos a cirurgia bariátrica e avaliar a gravidade da asma neste grupo de pacientes. MÉTODOS: Estudo transversal, envolvendo 363 pacientes obesos adultos (índice de massa corpórea > 35 kg/m²) avaliados por um médico pneumologista, utilizando a avaliação clínica como instrumento diagnóstico de asma. Todos os pacientes foram submetidos à avaliação clínica e espirometria e foram divididos em dois grupos (asma e controle). Os pacientes com asma foram classificados conforme a gravidade da doença. RESULTADOS: A prevalência de asma na população de obesos estudada foi de 18,5 por cento (IC95 por cento: 14,5-22,4). Essa prevalência nas mulheres e nos homens foi de 20,4 por cento (IC95 por cento: 16,2-24,5) e 13,7 por cento (IC95 por cento: 10,1-17,2), respectivamente. Havia sintomas de asma nos últimos doze meses em 8,0 por cento (IC95 por cento: 5,2-10,7), e houve manifestação inicial dos sintomas de asma na infância/adolescência em 17,4 por cento (IC95 por cento: 13,5-21,3). No grupo asma, asma intermitente estava presente em 29 pacientes (43,3 por cento); asma persistente leve, em 7 (10,4 por cento); asma moderada, em 25 (37,3 por cento); e asma persistente grave, em 6 (9,0 por cento). CONCLUSÕES: A prevalência de asma neste grupo de adultos obesos, utilizando-se a avaliação clínica como critério diagnóstico, mostrou-se elevada, com predomínio no sexo feminino e com manifestação inicial dos sintomas de asma na infância/adolescência. A gravidade da asma neste grupo de obesos adultos esteve entre os valores médios estimados para a população geral, com uma maior proporção de asma intermitente, asma persistente leve e asma persistente moderada.

OBJECTIVE: To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS: This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m²) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS: The prevalence of asthma in the obese population studied was 18.5 percent (95 percent CI: 14.5-22.4). That prevalence was 20.4 percent (95 percent CI: 16.2-24.5) and 13.7 percent (95 percent CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0 percent (95 percent CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4 percent (95 percent CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3 percent), mild persistent asthma in 7 (10.4 percent), moderate asthma in 25 patients (37.3 percent), and severe persistent asthma in 6 (9.0 percent). CONCLUSIONS: Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominated.

Efeito do laser de baixa potência na cicatrização de ferida cirúrgica em ratos / Effect of low level laser on sutured wound healing in rats

PURPOSE: To evaluate the effect of low-level laser therapy (LLLT) ë904 nm on healing of surgical wounds in rats. METHODS: Forty male Wistar rats were used, divided into four groups, underwent incision along the lines Alba covering skin, subcutaneous and muscle abdominal, sutured continuously for nylon 5-0. Eight and fifteen days after the surgery process, the repairing area was removed and histological sections were stained with hematoxylin-eosin to assess cellularity inflammatory, Masson's Trichrome and Picrossirus to quantify the collagen fibers and immunohistochemical technique for counting newly formed vessels. The data were compared statistically using analysis of variance ANOVA, with a "post-hoc Tukey test, p <0.05. RESULTS: Low-level laser therapy reduced the intensity of the inflammatory reaction and influenced the dynamic of the immunoinflammatory response by inducing switching of the leukocyte infiltration pattern (neutrophilic to lymphoplasmacytic infiltration). Also stimulate the deposition and enhance the organization of collagen fibers, featuring a delicate collagen type III. Furthermore, it appeared to a significant increase in the average number of newly formed vessels (p = 0.00 and p = 0.02, respectively). CONCLUSION: Low-level laser therapy resulted in modulate of the inflammatory response, enhanced deposition of collagen fibers and increase in the average number of newly formed vessels.

OBJETIVO: Avaliar o efeito da terapia laser de baixa potência (TLBP) ë904 nm na cicatrização de feridas cirúrgicas em ratos. MÉTODOS: Foram utilizados 40 ratos Wistar, machos, divididos em quatro grupos, submetidos à incisão na linha Alba abrangendo pele, subcutâneo e musculatura abdominal, suturados continuamente por fios de nylon 5-0. Oito e quinze dias após o procedimento cirúrgico, a área de reparo foi removida e os cortes histológicos foram corados com hematoxilina-eosina para avaliar celularidade do infiltrado inflamatório, Tricrômico de Masson e Picrosirius para quantificar as fibras de colágeno e técnica imuno-histoquímica para a contagem de vasos neoformados. Os dados foram comparados estatisticamente pela análise de variância ANOVA, com "teste de Tukey post-hoc, p <0,05. RESULTADOS: A terapia laser de baixa potência reduziu a intensidade da reação inflamatória e influenciou a dinâmica da resposta imuno por induzir a mudança do padrão de infiltração de leucócitos (neutrófilos a infiltração mononuclear). Como também estimula a deposição e melhora padrão organizacional das fibras colágenas, apresentando um delicado colágeno tipo III. Além disso, verificou-se um aumento significativo no número médio de vasos neoformados (p = 0,00 e p = 0,02, respectivamente). CONCLUSÃO: A terapia laser de baixa potência modula a resposta inflamatória, com melhor deposição de fibras colágenas e aumento do número médio de vasos neoformados.

Effect of low level laser on sutured wound healing in rats.

PURPOSE: To evaluate the effect of low-level laser therapy (LLLT) ë904 nm on healing of surgical wounds in rats. METHODS: Forty male Wistar rats were used, divided into four groups, underwent incision along the lines Alba covering skin, subcutaneous and muscle abdominal, sutured continuously for nylon 5-0. Eight and fifteen days after the surgery process, the repairing area was removed and histological sections were stained with hematoxylin-eosin to assess cellularity inflammatory, Masson's Trichrome and Picrossirus to quantify the collagen fibers and immunohistochemical technique for counting newly formed vessels. The data were compared statistically using analysis of variance ANOVA, with a "post-hoc Tukey test, p <0.05. RESULTS: Low-level laser therapy reduced the intensity of the inflammatory reaction and influenced the dynamic of the immunoinflammatory response by inducing switching of the leukocyte infiltration pattern (neutrophilic to lymphoplasmacytic infiltration). Also stimulate the deposition and enhance the organization of collagen fibers, featuring a delicate collagen type III. Furthermore, it appeared to a significant increase in the average number of newly formed vessels (p = 0.00 and p = 0.02, respectively). CONCLUSION: Low-level laser therapy resulted in modulate of the inflammatory response, enhanced deposition of collagen fibers and increase in the average number of newly formed vessels.

Avaliação do tratamento de fissura anal crônica com isossorbida tópica a 1 por cento / Evaluation of the treatment of chronic anal fissure with topical isosorbide 1 percent

INTRODUÇÃO: Fissuras anais crônicas são úlceras benignas, dolorosas, profundas. Ocorrem devido a trauma das fezes, hipertonia esfincteriana e pobre vascularização. Cirurgia é mais efetiva, porém com efeitos adversos (incontinência anal). Terapia conservadora consegue decréscimo transitório da pressão de repouso, cicatrizando muitas lesões, sem dano muscular. MÉTODOS: Objetivando avaliar tratamento de fissuras crônicas com isossorbida (ISO) a 1 por cento tópica, foi realizado um ensaio clínico, duplo-cego em pacientes do Serviço de Coloproctologia da Universidade Federal de Sergipe (UFS) - Aracaju, Sergipe, durante um ano. Foram estudados 24 pacientes: 14 no Grupo 1 - creme com ISO, e 10 no Grupo 2 - placebo. Avaliaram-se comportamento da pressão de repouso, melhora da dor e grau de cicatrização das feridas com e sem ISO. RESULTADOS: Resultados mostraram que a fissura acometeu mais mulheres, a constipação foi observada em 58,3 por cento. Quanto à dor, obteve-se menor intensidade no Grupo 2, mas sem significância. A cicatrização ao fim de 60 dias foi igual nos dois grupos (50 por cento). Quanto às médias de pressão de repouso com 30 e 60 dias, houve queda no padrão em ambos os grupos, porém sem significância. Observou-se que pacientes curados foram os de maior redução de pressão de repouso. CONCLUSÃO: Concluiu-se que a ISO não modificou o padrão de resposta manométrica; todavia, houve melhora clínica importante nos dois grupos, cuja taxa de cicatrização foi equivalente.

INTRODUCTION: Chronic anal fissures are deep, benign and painful ulcers. The involved factors are local trauma, sphinter hypertonia and poor blood flow. Surgery is gold standard treatment, but it causes fecal incontinence. Medical non-surgical therapy gets transitory resting pressure reduction and cure of lesions, without muscular damage. METHODS: In order to evaluate the treatment of chronic anal fissures using topical isossorbide (ISO) 1 percent, a randomizated and double-blind study twas carried out in Coloproctology Section of Universidade Federal de Sergipe (UFS), Sergipe, Brazil, during one year. Twenty-four patients were evaluated: 14 in Group 1 - ISO cream, and 10 in Group 2 - placebo. Resting pressure profile, improvement of painful symptoms and degree of scaring of the fissure were evaluated. RESULTS: Ulcer was more prevalent in women, constipation was present in 58.3 percent. The evacuatory pain was less common in Group 2, but without statistical significance. After 60 days, the healing was equal in the both groups (50 percent). There was a small reduction of resting pressure means at the end of 30 and 60 days, without statistical significance. Healing patients presented more resting pressure reducing. CONCLUSION: ISO cream did not influence the manometric response standard; otherwise it offered clinical improvement in both groups, whose scarring index was similar.

Envelhecimento pulmonar acelerado em pacientes com obesidade mórbida / Accelerated lung aging in patients with morbid obesity

OBJETIVO: Determinar a idade pulmonar de pacientes com obesidade mórbida e compará-la com a idade cronológica desses pacientes, ressaltando o dano precoce da obesidade mórbida sobre os pulmões. MÉTODOS: Estudo transversal, prospectivo e aberto que envolveu 112 indivíduos: 78 pacientes com obesidade mórbida (grupo de estudo) e 34 indivíduos não obesos e com função pulmonar normal (grupo controle). Todos os pacientes realizaram espirometria para a determinação da idade pulmonar. A idade pulmonar e a idade cronológica dos indivíduos em cada grupo foram comparadas isoladamente e entre os grupos. RESULTADOS: A diferença entre a idade pulmonar e a idade cronológica no grupo com obesidade mórbida foi significativa (p < 0,0001; IC95 por cento: 6,6-11,9 anos), com uma diferença média de 9,1 ± 11,8 anos. A diferença da idade pulmonar entre o grupo de estudo e o grupo controle foi significativa (p < 0,0002; IC95 por cento: 7,5-16,9 anos), com uma diferença média de 12,2 ± 2,4 anos. A idade pulmonar demonstrou uma correlação positiva com a idade cronológica e o índice de massa corpórea (IMC) e uma correlação negativa com as variáveis espirométricas (p < 0,0001 para todos). A análise de regressão linear múltipla identificou as variáveis IMC e idade cronológica (p < 0,0001) como fatores preditivos significativos da idade pulmonar. CONCLUSÕES: A idade pulmonar está aumentada em pacientes com obesidade mórbida, sugerindo dano precoce e envelhecimento pulmonar acelerado, como evidenciado pela discrepância entre a idade cronológica e idade pulmonar. A determinação da idade pulmonar pode se tornar uma nova ferramenta na compreensão dos resultados da função pulmonar para pacientes e profissionais da saúde em relação ao controle da obesidade.

OBJECTIVE: To determine the lung age of patients with morbid obesity and to compare it with the chronological age of these patients, emphasizing the premature damage that morbid obesity does to the lungs. METHODS: An open, prospective cross-sectional study comprising 112 individuals: 78 patients with morbid obesity (study group); and 34 non-obese individuals with normal pulmonary function results (control group). All of the patients underwent spirometry for the determination of lung age. The lung age and the chronological age of the individuals in each group were compared in isolation and between the two groups. RESULTS: The difference between lung age and chronological age in the group with morbid obesity was significant (p < 0.0001; 95 percent CI: 6.6-11.9 years), the mean difference being 9.1 ± 11.8 years. The difference between the study group and the control group in terms of lung age was significant (p < 0.0002; 95 percent CI: 7.5-16.9 years), the mean difference being 12.2 ± 2.4 years. Lung age correlated positively with chronological age and body mass index (BMI), whereas it correlated negatively with the spirometric variables (p < 0.0001 for all). Multiple linear regression analysis identified BMI and chronological age (p < 0.0001) as significant predictors of lung age. CONCLUSIONS: Lung age is increased in patients with morbid obesity, suggesting premature damage and accelerated lung aging, as evidenced by the discrepancy between chronological age and lung age. The determination of lung age might become a new tool for understanding pulmonary function results, for patients as well as for health professionals, in relation to obesity control.

[Mesenteric cyst--clinical and pathological aspects]. / Cisto mesentérico--aspectos clínicos e anátomopatológicos.

OBJECTIVE: To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil. METHODS: Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach. RESULTS: Eighteen cases of mesenteric cysts were found. Females were more affected (72.2%). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases. CONCLUSION: The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete resection of the cyst was the treatment of election. There were no deaths in postoperative period.

Cisto mesentérico: aspectos clínicos e anátomopatológicos / Mesenteric cyst: clinical and pathological aspects

OBJETIVO: Discutir aspectos epidemiológicos, clínicos, anátomo-patológicos e terapêuticos de cistos mesentéricos atendidos em hospitais do Estado de Sergipe. MÉTODOS: Estudo observacional, descritivo e transversal, consistindo de um levantamento de uma série de casos de cistos mesentéricos, nos arquivos do Laboratório de Patologia da Universidade Federal de Sergipe no período de 1995 a 2007. Revisaram-se os prontuários dos pacientes para coleta de dados: gênero, idade, quadro clínico, exames complementares e abordagem terapêutica. RESULTADOS: Foram encontrados 18 casos de cistos mesentéricos. O gênero predominante foi o feminino (72,2 por cento). A média de idade dos pacientes ao diagnóstico foi de 30,48 anos. Os sintomas mais freqüentes foram dor e massa abdominal. A ultra-sonografia de abdome, realizada em todos os pacientes, não foi conclusiva em metade dos casos. Tomografia computadorizada de abdome com contraste foi realizada em seis casos, sendo a tumoração cística bem evidenciada em todos estes. Quanto ao tipo histopatológico foram encontrados oito linfangiomas, oito cistos mesoteliais, um cisto hemorrágico em organização e um cisto mucinoso. O tratamento cirúrgico foi empregado em todos os casos. Hemorragia intracística foi a principal complicação apresentada, ocorrendo em três casos. CONCLUSÃO: Os cistos mesentéricos apresentaram-se clinicamente com sintomas inespecíficos e pouco sintomáticos. Quanto ao diagnóstico, a tomografia computadorizada mostrou ser mais efetiva que a ultrassonografia. Linfangiomas e mesoteliomas foram encontrados em proporções iguais. A ressecção completa do cisto foi o tratamento de eleição e não houve óbitos no pós-operatório.

OBJECTIVE: To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil. METHODS: Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach. RESULTS: Eighteen cases of mesenteric cysts were found. Females were more affected (72.2 percent). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases. CONCLUSION: The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete ressection of the cyst was the treatment of election. There were no deaths in postoperative period.

Accelerated lung aging in patients with morbid obesity.

OBJECTIVE: To determine the lung age of patients with morbid obesity and to compare it with the chronological age of these patients, emphasizing the premature damage that morbid obesity does to the lungs. METHODS: An open, prospective cross-sectional study comprising 112 individuals: 78 patients with morbid obesity (study group); and 34 non-obese individuals with normal pulmonary function results (control group). All of the patients underwent spirometry for the determination of lung age. The lung age and the chronological age of the individuals in each group were compared in isolation and between the two groups. RESULTS: The difference between lung age and chronological age in the group with morbid obesity was significant (p < 0.0001; 95% CI: 6.6-11.9 years), the mean difference being 9.1 ± 11.8 years. The difference between the study group and the control group in terms of lung age was significant (p < 0.0002; 95% CI: 7.5-16.9 years), the mean difference being 12.2 ± 2.4 years. Lung age correlated positively with chronological age and body mass index (BMI), whereas it correlated negatively with the spirometric variables (p < 0.0001 for all). Multiple linear regression analysis identified BMI and chronological age (p < 0.0001) as significant predictors of lung age. CONCLUSIONS: Lung age is increased in patients with morbid obesity, suggesting premature damage and accelerated lung aging, as evidenced by the discrepancy between chronological age and lung age. The determination of lung age might become a new tool for understanding pulmonary function results, for patients as well as for health professionals, in relation to obesity control.

Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva? / Bariatric surgery: is admission to the intensive care unit necessary?

OBJETIVOS: Determinar o local de internação no pós-operatório de cirurgia bariátrica primária e verificar as complicações clínicas-cirúrgicas que justificassem internação em unidade de terapia intensiva, inclusive morte. MÉTODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos à cirurgia bariátrica primária por vídeolaparoscopia no período de maio de 2007 a abril de 2008 em um hospital terciário. Utilizou-se o índice de Aldrete e Kroulik para liberação da sala de recuperação pós-anestésica e definição do local de encaminhamento no pós-operatório. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com média de idade 35,4 ± 10,5 anos (18 a 66 anos), índice de massa corpórea médio 45,6 ± 10,5. O tempo entre admissão hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirúrgico 105,0 ± 28,6 minutos, o tempo de permanência na sala de recuperação pós-anestésica foi 125,0 ± 38,0 minutos e tempo de internação hospitalar 47,7 ± 12,4 horas, com 100 por cento dos pacientes deambulando em 24 horas. O índice de Aldrete e Kroulik da sala de recuperação pós-anestésica alcançou pontuação de 10 com 120 minutos em todos os pacientes, com sobrevida de 100 por cento. CONCLUSÃO: Com o uso do índice Aldrete e Kroulik na sala de recuperação pós-anestésica de bypass gástrico por videolaparoscopia em cirurgia bariátrica primária, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicação maior foi observada.

OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was used for release from the post-anesthesia recovery room and to define where the patient should be routinely referred for postoperative. RESULTS: Among the 120 patients, 83 were women and 37 men with a mean age ranging from 35.4 ± 10.5 years (18 to 66 years), body mass index 45.6 ± 10.5. The time between hospital admission and start of surgery was 140.7 ± 81.8 minutes, surgery time was 105 ± 28.6 minutes, time of post-anesthesia recovery room was between 125 ± 38 minutes and length of hospital stay was 47.7 ± 12.4 hours, with 100 percent of the patients walking in 24 hours. The Aldrete and Kroulik index in the post-anesthesia recovery room achieved scores of 10 to 120 minutes in all patients, with a 100 percent survival . CONCLUSION: Using the Aldrete and Kroulik index in the post-anesthesia of gastric bypass by video laparoscopy in primary bariatric surgery, no patient was admitted in intensive care unit and no major complication was observed.