Segurança do paciente: alterações da hemoglobina e ferro sérico após lipoaspiração e/ou abdominoplastia / Patient safety: changes in hemoglobin and serum iron after liposuction and/or abdominoplasty

Introdução: A lipoaspiração é o sendo segundo procedimento mais realizado no Brasil. Com os avanços da técnica, melhores equipamentos e aumento da segurança no ambiente cirúrgico, passaram-se a ser lipoaspiradas grandes áreas. Contudo, existe uma preocupação com a segurança do paciente. Comitês de segurança têm feito recomendações sobre a infiltração, anestesia, seleção do paciente, volume aspirado, entre outros. A Sociedade Brasileira de Cirurgia Plástica e o Conselho Federal de Medicina também determinaram parâmetros de volumes de segurança do aspirado e superfície corporal aspirada. Ainda assim, a literatura de apoio para as recomendações é escassa. O objetivo é avaliar as alterações dos níveis de hemoglobina, ferro sérico e proteínas totais no pré e pós-operatório mediato (7-10 dias), assim como seus reflexos nos pacientes. Métodos: Realizamos um estudo prospectivo, com pacientes submetidos à lipoaspiração isolada e associada à dermolipectomia abdominal, por indicações estéticas. Avaliamos 30 pacientes, sendo coletados dados demográficos, peso, Índice de Massa Corporal, níveis de hemoglobina, ferro sérico e proteínas totais, no pré-operatório, e entre 7 a 10 dias de pós-operatório. Resultados: A queda da hemoglobina foi entre 2-6g/dl, com média de 3,1g/dl aos 7-10 dia de PO. Tivemos como valor mínimo de hemoglobina 7,8g/dl no pós-operatório com 7-10 dias, enquanto o ferro sérico apresentou redução média de 44,87g/dl. Conclusão: A redução no nível da hemoblogina foi responsável pela sintomatolgia clinica apresentada. A reposição de ferro se mostrou necessária no pós-operatório imediato.

Introduction: Liposuction is the second commonest procedure performed in Brazil. The scope for liposuction has broadened with advances in the technique, with better equipment, and increased safety in the surgical environment. However, there are concerns about patient safety. Safety committees have made recommendations on various aspects of the procedure including infiltration, anesthesia, patient selection, and aspirated volume. The Brazilian Society of Plastic Surgery and the Federal Council of Medicine have also determined the parameters for aspiration safety volumes, and for the aspiration of body surface. However, supporting literature for the recommendations is scarce. The objective is to evaluate changes in hemoglobin, serum iron, and total protein levels in the peri-operative days (between 7 and 10 days), in addition to its impact in patients. Methods: We performed a prospective study, with patients submitted to either liposuction alone, or in conjunction with abdominal dermolipectomy for esthetic indications. We evaluated 30 patients, collecting their demographic data, weight, body mass index, hemoglobin, serum iron, and total protein levels in both, the pre-operative period, and between 7 and 10 post-operative days. Results: The fall in hemoglobin levels were between 2 and 6 g /dL, with an average of 3.1 g /dL between 7 and 10 post-operative days . A minimum hemoglobin value of 7.8 g/dL was noted between 7 and 10 days after surgery, while the mean reduction of serum iron was found to be 44.87 g/dL. Conclusion: The reduction in hemoglobin levels was responsible for the clinical symptoms. Iron supplementation was required in the immediate post-operative period.

Tuberculosis miliar con diseminación renal y genitourinaria: reporte de un caso / Miliary tuberculosis, with renal and genitourinary disemination; Case Report

Antecedentes: A pesar de los grandes avances en la medicina contemporánea; la Tuberculosis continúa siendo un reto diagnóstico, en especial al presentarse con características clínicas poco usuales. Caso clínico: Paciente masculino de 48 años, agri-cultor, de escasos recursos económicos, sin comorbilidades previas, el cual presenta sintomatología constitucional, pérdida de peso, iebre y dolor lumbar irradiado a ambos lancos de la región abdominal, de características poco especíicas, de un mes de evolución; acompañado de disuria y oliguria, y niega síntomas respiratorios. Al examen físico luce crónicamente enfermo, en mal estado nutricio-nal, sin deterioro de la conciencia, no se evidencia adenopatías cervicales ni inguinales; sin presencia de signos pulmonares, con leve dolor con la puño percusión renal bilateral, en el área genital, se identiica una masa de borde regular, móvil sobre el polo superior del testículo derecho. En el examen hematológico con presencia de Bicitopenia anemia microcitica hipocromica y trombocitopenia leve, en gases arteriales acidosis metabólica con Anión Gap elevado, además con hiperazoemia e hiperkalemia en la bioquímica sanguínea refractaria al tratamiento, razón por la cual fue sometido a Hemodiálisis aguda. Al evaluar radiografía de tórax se observa patrón micro-nodular difuso, no se realiza baciloscopias por falta de expectoración ni por lavado gástrico, en el ultrasonido renal y de vías urinarias se visualizó nefromegalia y la presencia de masa heterogénea de aspecto granulomatoso en testículo derecho; por lo que se solicitó tomografía toracoabdominal, en donde se observa patrón micronodular múltiple a nivel pulmonar, con afectación renal, ganglionar y testicular, se solicita BAAR de sedimento urinario seriado con resultados positivos, y la tinción Ziehl Neelsen en orina con resultado positivo; con ello se inicia terapia antiimica. Discusión: La Tuberculosis renal no tiene un cuadro clínico clásico; generalmente se presenta con manifestaciones atípicas; como en nuestro caso con sintomatología urinaria, hiperazoemia que culmino en terapia de restitución renal de emergencia, con posterior recuperación de la función renal.

Factores de riesgo asociados a la prevalencia de anemia ferropénica en niños de 24 a 59 meses de edad atendidos en el Hospital Militar Escuela Doctor Alejandro Dávila Bolaños enero a diciembre del 2009 / Risk factors related to the prevalence of iron deficiency anemia in children 24-59 months of age treated at the Military Training Hospital Doctor Alejandro Dávila Bolaños January to December 2009

El objetivo del presente estudio fue valorar los factores de riesgo que se asocian a la prevalencia de anemia ferropénica en un grupo de niños (1892) que ingresaron a la sala de hospitalización pediátrica en edades de dos a cinco años en el periodo correspondiente de Enero a Diciembre del 2009, de estos 357 presentaron hemoglobina menor de 11 gr/dl (valor de referencia por debajo del cual debe considerarse anemia según OMS) a partir de los cuales se seleccionaron 110 casos (niños anémicos) y 220 controles (no anémicos) a través del software Epi info 6.04 utilizando los siguientes parámetros: OR: 2, frecuencia de exposición entre los controles 50%, nivel de seguridad 95% y poder estadístico de 80%. El muestreo se realizó de forma aleatoria simple, tanto para los casos como para los controles. La prevalencia de anemia en el universo estudiado es de 18.9%, el 20% de los casos presentaba desnutrición con respecto a los controles los cuales tenían un 8.3%, el nivel de analfabetismo de la madre de los niños en ambos grupos alcanzó un 4.8%, la infección parasitaria en ambos grupos representó el 37.6%, de estos los más afectados son los niños anémicos (51.8%). La anemia microcítica hipocrómica fue la que predominó en el grupo casos, se observó un 5.4% de anemia moderada, con hemoglobina entre el rango de 7 a 9 gr/dl. Se concluyó que son factores de riesgo para anemia los siguientes: Presentar algún tipo de desnutrición, Ser hijo de madre que no haya estudiado o que sólo haya cursado primaria incompleta, que el niño tenga algún tipo de infección parasitaria (excepto por saprófito) y Presentar más de tres episodios en el año de enfermedad diarreica. Se recomendo Indicar tratamiento intrahospitalario y/o ambulatorio con hierro en los casos que lo ameriten y de no poderse indicar, se debe dar seguimiento por la consulta externa...

Bleeding disorders: A common cause of menorrhagia in adolescents.

OBJECTIVE: To determine the frequency of underlying bleeding disorders in adolescents with menorrhagia. STUDY DESIGN: We retrospectively reviewed the charts of all girls, aged 10 to 19 years, who presented to our children's hospital for inpatient or outpatient evaluation of menorrhagia between January 1990 and November 1998. RESULTS: At presentation, 9 of the 71 girls (13%) had thrombocytopenia (platelet count <150,000/microL; range, 5000-106,000/microL). The most common causes for thrombocytopenia were immune thrombocytopenic purpura (n = 5) and myelosuppression caused by chemotherapy (n = 2). Of 14 girls who underwent a more detailed hemostatic evaluation, 8 were given a diagnosis of a hereditary coagulation disorder: 6 had platelet function defects and 2 had type 1 von Willebrand disease. Excessive menstrual bleeding commonly results in anemia. One half of the total group had anemia (hemoglobin <12.0 g/dL). Seven girls (10%) had potentially life-threatening anemia (hemoglobin <5.0 g/dL). CONCLUSIONS: Acquired and congenital bleeding disorders are common causes of menorrhagia in adolescent girls. Severe anemia is a frequent complication of menorrhagia. We recommend that adolescents without thrombocytopenia who present with menorrhagia receive a comprehensive hemostatic evaluation, including testing for von Willebrand disease and platelet function defects.

Pigmentaçäo bucal e anemia: apresentaçäo de um caso / Oral pigmentation and anemia: report of a case

Os autores apresentam o caso de um paciente de 35 anos do sexo masculino, branco que apresentava lesöes pigmentadas orais associadas a disfagia, cujo único fator predisponente era anemia ferropriva de longa data, secundária e gastrectomia. O caso reveste-se de interese pela sua particularidade, assim como pelo diagnóstico diferencial com outras patologias, além do tempo necessário para identificar-se a etiologia

[Cervical esophageal membrane and Plummer-Vinson syndrome: report of a caseload and review of the literature]. / Membrana esofágica cervical e síndrome de Plummer-Vinson: apresentação de casuística e revisão da literatura.

Esophageal webs are an uncommon group among esophageal diseases. We report our findings in ten patients with membranes in the upper esophagus; seven of them were women. The median age was 48.5 years (range 24 to 73 years). Dysphagia was the main symptom in all patients and anemia was found in six cases. Radiologic and endoscopic studies provided the diagnosis. All patients underwent endoscopic dilatation and/or debridement and good results with this management were achieved. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Repercusión de la anemia ligera por deficiencia de hierro sobre el desarrollo psicomoto en niños de 6 a 19 meses de edad / Repercusion of ild anemia due to iron deficiency upon psychomotor development in children 6-19 months of age

Se evaluaron 90 niños saludables entre 6 y 19 meses de edad, con el objeto de conocer la relación de la anemia por deficiencia de hierro con el desarrollo psicomotor. Se clasificaron en deficientes según el número de indicadores de la deficiencia de hierro alterados, y se hallaron valores promedio del índice mental significativamente más bajos en el grupo deficiente. No se encontró correlación significativa del nivel socioeconómico y cultural con el índice mental ni el índice motro. Se hallaron correlaciones significativas del índice mental con la hemoglobina y del índice mental con la protoporfirina eritrocitaria libre. Se concluye que las alteraciones del índice mental halladas en el presente estudio plantean, con una elevada probabilidad, la influencia de la deficiencia de hierro, dada en una de las muestras más numerosas y con anemia con deficiencia de hierro más ligera informada hasta el presente, después de descartar la presencia de otras carencias nutricionales, así como de un grupo de factores demográficos, sociales y del estado de salud (AU)

Repercusión de la anemia ligera por deficiencia de hierro sobre el desarrollo psicomoto en niños de 6 a 19 meses de edad / Repercusion of mild anemia due to iron deficiency upon psychomotor development in children 6-19 months of age

Se evaluaron 90 niños saludables entre 6 y 19 meses de edad, con el objeto de conocer la relación de la anemia por deficiencia de hierro con el desarrollo psicomotor. Se clasificaron en deficientes según el número de indicadores de la deficiencia de hierro alterados, y se hallaron valores promedio del índice mental significativamente más bajos en el grupo deficiente. No se encontró correlación significativa del nivel socioeconómico y cultural con el índice mental ni el índice motro. Se hallaron correlaciones significativas del índice mental con la hemoglobina y del índice mental con la protoporfirina eritrocitaria libre. Se concluye que las alteraciones del índice mental halladas en el presente estudio plantean, con una elevada probabilidad, la influencia de la deficiencia de hierro, dada en una de las muestras más numerosas y con anemia con deficiencia de hierro más ligera informada hasta el presente, después de descartar la presencia de otras carencias nutricionales, así como de un grupo de factores demográficos, sociales y del estado de salud

Esophageal motility impairment in Plummer-Vinson syndrome. Correction by iron treatment.

We report the case of a 41-year-old woman with Plummer-Vinson syndrome and an esophageal motility disorder. She complained of dysphagia and odynophagia and had cheilitis, glossitis, and hypochromic anemia. An esophageal motility study showed low amplitude of contraction and high intrabolus pressure in the esophageal body. After iron replacement, the patient was free from symptoms, and a new motility study showed increased amplitude of contraction and decreased intrabolus pressure.

Independent effects of lead exposure and iron deficiency anemia on developmental outcome at age 2 years.

For a prospective study of lead exposure, iron status, and infant development, we recruited infants living in a smelter town and a non-lead-exposed town in Kosovo, Yugoslavia. Among 392 infants assessed at age 2 years, the mean Mental Development Index (MDI), Bayley Scales of Infant Development, was 105.2. At age 2 years, geometric mean blood lead concentrations were 35.5 and 8.4 micrograms/dl, respectively, among infants from the exposed and nonexposed towns. After controlling for variables associated with MDI, we found significant independent associations for both blood lead and hemoglobin concentrations. For example, a rise in blood lead concentration at age 2 years from 10 to 30 micrograms/dl was associated with an estimated 2.5 point decrement in MDI (p = 0.03); statistically nonsignificant decrements were associated with blood lead levels measured at birth and at 6, 12, and 18 months of age. A decrease in hemoglobin concentration at 18 months of age from 12 to 10 gm/dl was associated with an estimated 3.4 point decrement in MDI (p = 0.02); the latter association was present in both towns, suggesting that it was due to iron deficiency anemia independent of lead exposure. The findings suggest that the brain is vulnerable to the effects of both lead exposure and anemia before 2 years of age. On a global basis, the developmental consequences of anemia may exceed those of lead exposure.

Anormalidades imunologicas e susceptibilidade a infeccoes na anemia ferropriva / Imunological abnormalities and susceptibility the infections in hypochromic anemia

A relacao entre a incidencia de infeccoes e o estado nutricional de ferro e bastante controvertida, sendo relatados tanto maioir susceptibilidade como maior resistencia a infeccoes na anemia ferropriva. O ferro e essencial para o cresciemnto de mocroorganismos e a sua carencia ao lado de limitar a proliferacao dos mesmos determina alteracoes imunologicas no hospedeiro. Estas anormalidades caracterizam uma imunodeficiencia multifatorial, porem parcial. Assim, a susceptibilidade a infeccoes nos pacientes com anemia ferropriva seria determinada pelo balanco entre as alteracoes imunologicas e a limitacao do crescimento dos microorganismos condicionada pela carencia de ferro. Variacoes do equilibrio deste binomio poderiam explicar os resultadosdiscrepantes assinaladosna literatura

Effects of iron deficiency on lead excretion in children with moderate lead intoxication.

The effect of iron status on calcium disodium edetate (CaNa2EDTA)-induced lead diuresis was examined in 112 children with moderate lead intoxication. Patients whose blood lead levels were between 25 and 55 micrograms/dl and who had erythrocyte protoporphyrin concentrations greater than or equal to 35 micrograms/dl underwent provocative testing to determine the need for a full course of chelation therapy. A blood sample for lead, erythrocyte protoporphyrin, and serum ferritin determinations was obtained immediately before the intramuscular administration of CaNa2EDTA, 500 mg/m2. Determination of urinary lead level was based on an 8-hour urine collection. Blood lead and ferritin levels were significantly correlated with urinary lead excretion: r = 0.542 and 0.298, respectively, p less than 0.01 for both. Multiple regression models were tested to assess the independent effects of the variables. With blood lead level controlled, ferritin remained significantly associated with urinary lead excretion; for every 1 ng/ml increase in ferritin, urinary lead increased by 2.4 micrograms. This small effect of ferritin on urinary lead was illustrated in a discriminant analysis. Using blood lead level by itself as the independent variable resulted in a 76% correct assignment of provocative test outcomes. Knowing the ferritin level improved this assignment accuracy by only 3%. We conclude that the iron status, as measured by serum ferritin, of children with moderate lead intoxication, has a small but significant effect on CaNa2EDTA-induced lead diuresis. This effect may influence the interpretation of borderline provocative test outcomes. Although chelation therapy should not be withheld pending treatment of iron deficiency, lead stores should be reassessed after iron repletion.

[Iron deficiency in children: clinical manifestations, therapy and prevention. II]. / Deficiencia de hierro en la infancia: manifestaciones clínicas, tratamiento y prevención. Parte II.

A better understanding of the physiopathological and pathogenic characteristics underlying iron deficiency, has allowed for a more precise diagnosis and the opportune treatment of this disease. On the other hand, it has also permitted the designing of more efficient preventive programs. This study includes what is known to date and the applicable experiences when confronted with this problem in children. Iron deficiency; clinical manifestations; treatment; prevention.