Mastectomía libre de opioides bajo anestesia-analgesia epidural torácica en un paciente con estenosis traqueal crítica: caso clínico / Opioid-free mastectomy under thoracic epidural anesthesia-analgesia in a patient with critical tracheal stenosis: A case report

Mastectomy is traditionally performed under general anaesthesia and invasive ventilation, and is often complemented with regional techniques. In this setting, tracheal stenosis can pose a challenge to airway management. The aim of this report is to describe the successful management of a 68-year-old woman with severe subglottic tracheal stenosis undergoing mastectomy due to breast cancer. Surgery was performed without airway instrumentation under an opioid-free regimen consisting of thoracic epidural, propofol and dexmedetomidine perfusion, and non-opioid analgesics. Spontaneous ventilation and adequate perioperative analgesia were achieved. Opioid-free anaesthesia without airway instrumentation, consisting of thoracic epidural anaesthesia and sedation, is a good alternative in patients undergoing mastectomy in whom airway manipulation is best avoided.(AU)

La mastectomía se realiza tradicionalmente bajo anestesia general y ventilación invasiva, complementándose a menudo con técnicas regionales. En este contexto, la estenosis traqueal puede suponer un reto para el manejo de la vía aérea. El objetivo de este informe es describir el manejo exitoso de una mujer de 68 años de edad con estenosis traqueal subglótica severa, sometida a mastectomía debido a cáncer de mama. La cirugía se realizó sin instrumentación de la vía aérea bajo un régimen libre de opioides consistente en epidural torácica, propofol y perfusión de dexmedetomidina, y analgésicos no opioides, lográndose ventilación espontánea y analgesia perioperatoria adecuada. La anestesia libre de opioides sin instrumentación de la vía aérea, consistente en anestesia epidural torácica y sedación, es una buena alternativa en pacientes sometidos a mastectomía, en los que es mejor evitar la manipulación de la vía aérea.(AU)

O nível de condicionamento físico afeta a magnitude da carga interna de treinamento em jovens jogadores de basquetebol? / Does the level of fitness affect the magnitude of internal training load response in young basketball players?

Objetivo. O objetivo do estudo foi investigar a influência da capacidade de desempenhar sucessivos esforços de alta intensidade (CDEAI) na resposta da carga interna de treinamento (CIT) em jovens jogadores de basquetebol. Método. Doze jogadores de basquetebol fizeram parte da investigação (18,6 ± 0,5 anos, 192 ± 6,5 cm e 88,8 ± 14,5 kg). O estudo foi realizado em quatro semanas consecutivas de treinamento. As duas primeiras semanas pertencentes ao período preparatório (PP) e as duas últimas ao período competitivo (PC). O método da Percepção Subjetiva de Esforço da sessão (PSE da sessão) foi utilizado para quantificar a carga interna de treinamento (CIT) em todas as sessões de treinamento. Antes (Pre) e após (Pós) o período experimental de 4 semanas, os atletas realizaram o teste de Yo-Yo (Intermittnet Endurance test Level 2; Yo-Yo IE2). Para a análise dos dados se utilizou o coeficiente de correlação de Pearson (Yo-Yo IE2 [Pre e Pós] x CIT [Geral (PP e PC), PP e PC])(P < 0,05). Resultados. Correlações negativas, classificadas como "muito grande" entre os resultados do Yo-Yo IE2 Pre e CIT no PP (r = -0,81), PC (r = -0,72) e para o período como todo (Geral) (PP e PC) (r = -0,80), foram observadas. Correlação classificada como "muito grande" foi observada entre o desempenho no Yo-Yo IE2 Pós e a CIT durante o PP (r = -0,83), grande para o PC (r = -0,66) e muito grande para o Geral (r = -0,78). Conclusão. Os resultados do presente estudo sugerem a existência de uma forte correlação entre a CDEAI e CIT, indicando assim, a importância de se adotar um monitoramento integrado dessas variáveis, objetivando o ajuste regular da carga de treinamento(AU)

Objective. The aim of this study was to investigate the influence of the ability to perform high intensity effort (HIE) on internal training load (CIT) responses in young basketball players. Method. Twelve male basketball players took part of the investigation (18.6 ± 0.5 years, 192 ± 6.5 cm e 88.8 ± 14.5 kg). The investigation lasted four weeks, with two weeks of a preparatory period (PP) and two weeks of a competitive period (PC). Session ratings of perceived exertion (session-RPE) method was used to quantify internal training load in every training session. Athletes performed the Yo-Yo Intermittent Endurance Test level 2 (Yo-Yo IE2) before and after the experimental period (4 weeks). For data analysis, Pearson correlation coefficient was used (Yo-Yo IE2 [PRE and POST] x CIT [General (PP and PC), PP and PC]) (p < 0.05). Results. Negative correlation coefficients, classified as "large" to very large", were observed between the performance in the Yo-Yo IE2 PRE and ITL in PP (r = -0.81), CP (r = -0.72), and in the whole experimental period (PP and CP) (r = -0.80) conditions. Correlation coefficients, classified as "large" to "very large", were also observed between the performance in the Yo-Yo IR2 POST and ITL during PP (r = -0.83), CP (r = -0.66) and General (r = -0.78) conditions. Conclusion. The results of the present study suggest the existence of a strong correlation between the ability to perform HIE and ITL, thus indicating the importance of adopting an integrated monitoring of these variables, aiming to conduct regular adjustments on training load(AU)

La psoriasis afecta de forma similar a los pacientes brasileños de ascendencia africana y caucásica / Psoriasis affects individuals of African descent and white Brazilians similarly

Introduction: Cultural, socio-demographic and environmental factors such as tropical climate and exposure to sun could have an impact on the incidence or clinical course of psoriasis. Here we describe the main clinical aspects of psoriasis in Brazilian patients and also investigate whether any particular feature can distinguish the disease occurring in Brazil from that occurring in other countries. Material and methods: We recorded the clinical features of 151 psoriasis patients seen in a Brazilian public dermatological care unit between 2006 and 2008. Results: Males and females were similarly affected. The reported races were as follows: whites, 47 cases (41.6%), interracial individuals (mixed race), 42 cases (37.2%) and blacks, 24 cases (21.2%). Chronic plaque-type psoriasis was the most prevalent clinical form (110 cases, 72.8%) followed by palm and sole involvement (21 cases, 13.9%). Conclusions: We demonstrated that psoriasis in these Brazilian subjects was similar to that observed in subjects from other countries, but interracial and black populations were affected as much as whites. Considering the high rate of interracial populations among Brazilians we cannot exclude the possibility that Afro-descendants may have inherited Caucasian genes associated with psoriasis. Poor socio-economic conditions of Afro-descendants can limit their possibilities of receiving adequate treatments, impairing their health-related quality of life (AU)

Introducción: Los factores culturales, sociodemográficos y ambientales tales como el clima tropical o la exposición solar pueden tener un impacto en la incidencia o el curso clínico de la psoriasis. En este artículo describimos los principales aspectos clínicos de la psoriasis en pacientes brasileños e investigamos si existe alguna característica que permita distinguir la enfermedad que ocurre en Brasil de la que se encuentra en otros países. Material y métodos: Se recogieron las características clínicas de 151 pacientes con psoriasis evaluados en un centro dermatológico público de Brasil entre 2006 y 2008. Resultados: Los hombres y las mujeres estaban afectados de forma similar. La frecuencia de afectación según la raza era la siguiente: blancos 47 casos (41,6%), mestizos 42 casos (37,2%) y negros 24 casos (21,2%). Las formas clínicas más prevalentes fueron la psoriasis crónica en placas (110 casos, 72,8%) seguida de la psoriasis palmoplantar (21 casos, 13,9%). Conclusiones: Demostramos que la psoriasis en estos sujetos brasileños es similar a la que se observa en sujetos de otros países, pero los mestizos y los negros están afectados tanto como los blancos. Teniendo en cuenta la elevada proporción de población mestiza entre los brasileños, no podemos descartar la posibilidad de que los descendientes africanos hayan podido heredar los genes caucásicos asociados a la psoriasis. Las pobres condiciones socioeconómicas de los descendientes africanos pueden limitar sus posibilidades para recibir tratamientos adecuados, lo que altera su calidad de vida (AU)

Moyamoya disease. Report of three cases in Brazilian patients.

Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease of unknown etiology reported mainly in the Japanese. Most cases occur in children. The disease is rare in non-Oriental adults manifesting itself mostly as intracerebral hemorrhages. We describe MMD in 2 non-Oriental young adults and one adolescent that developed cerebral infarctions. The adults were medicated with aspirin and no medication was given to the adolescent. All patients did not deteriorate in a follow-up period from 1 to 4 years. Although rare, MMD is an important cause of stroke in young individuals and may well be underreported: only 18 patients have been reported till 1997 in Brazil. Neurologists should include MMD in differential diagnosis of ischemic and hemorrhagic strokes in young adults.

[Basilar ectasia and stroke: clinical aspects of 21 cases]. / Ectasia da artéria basilar e acidente vascular cerebral. Aspectos clínicos de 21 casos.

Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

[Basilar ectasia and stroke: imaging features in 21 cases]. / Ectasia da artéria basilar e acidente vascular cerebral. Estudo por imagem em 21 casos.

Ectasia of the basilar artery (EB) may cause different clinical manifestations, and its analysis by imaging methods is fundamental. We tried to analyse radiological aspects in 21 patients with stroke and EB. In all of them, diagnosis could be done by computed tomography. However, magnetic resonance was the most complete diagnostic method for the evaluation of the relationship between EB an surrounding structures.

[Socioeconomic characteristics of patients with stroke]. / Características sócio-econmicas de pacientes com acidente vascular cerebral.

We studied the socioeconomic status of 206 stroke patients seen at Escola Paulista de Medicina--São Paulo in the period of 1991-1992. We found that 25% of patients were less than 50 years old; men were married significantly more often than women; 82% of patients had less than 8 years of formal education and 60% of the families survived with US$ 98 to 198. The socioeconomic impact caused by a stroke is very important. Low education and poverty influence the treatment and prevention of the disease. The Social Assistance Service can detect and attempt to solve the social problems in order to obtain a better control of systemic diseases and risk factors for stroke, and to give orientation concerning the local resources.