Radiographic evaluation of the glenohumeral joint space in patients undergoing arthroscopic shoulder surgery in the beach-chair position.

BACKGROUND: Shoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position. METHODS: GH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction. RESULTS: GH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction. CONCLUSION: Appropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.

Fístula colobrônquica por adenocarcinoma de cólon: relato de caso / Colobronchial fistula due to colon adenocarcinoma: case report

Fístula colobrônquica é uma complicação rara de doença do trato gastrintestinal. Geralmente manifesta com sintomatologia respiratória inespecífica, o que dificulta o diagnóstico. Pode ser a primeira manifestação da doença abdominal, refletindo quadro avançado e, portanto, de difícil abordagem. Relatamos o caso de uma paciente do sexo feminino, 72 anos, que apresentou fístula colobrônquica por adenocarcinoma de cólon no ângulo esplênico, manifestada por tosse crônica.(AU)

The colobronchial fistula is a rare complication of gastrointestinal tract disease. It is usually manifested with nonspecific respiratory symptomatology, which makes diagnosis difficult. It may be the first manifestation of abdominal disease, reflecting advanced disease and therefore being difficult to approach. We report a case of a female patient, 72 years old, who presented with colobronchial fistula due to colon adenocarcinoma in the splenic angle, manifested by chronic cough.(AU)

Influências do peso da mochila escolar em estudantes do ensino fundamental: uma revisão bibliográfica / Influences of backpack weight on elementary school students: a literature review

Este artigo apresenta uma revisão bibliográfica sobre o peso excessivo das mochilas de escolares e seu potencial prejuízo na saúde desses alunos. Diversos estudos revisados consideram que a carga da mochila adequada é de até 10% da massa corporal, sendo de 10 a 15% aceitável, porém podendo causar algum dano. Se superior a 15% da massa corporal, a carga da mochila sobrecarrega a coluna, provocando alterações posturais, dor, disfunção e alterações metabólicas, observadas no momento estudado. Pressupõe-se que haja prejuízo futuro com o uso de mochilas com carga acima de 15% da massa corpórea. Observou-se também que uma reeducação envolvendo a maneira correta de utilização da mochila com redução da carga é de grande valia como atividade preventiva desses malefícios, sendo o meio de ação mais simples e eficaz. Identifica-se, portanto, uma necessidade de estudos com foco na evolução das possíveis lesões e melhor abordagem preventiva e de tratamento.

This article presents a bibliographical review about the excessive weight of schoolchildren?s backpacks and its potential harm to their health. Several reviewed studies consider that the proper backpack load is up to 10% of body mass, being acceptable between 10 and 15%, however, with the potential to cause some damage. The backpack load overloads the spine causing postural changes, pain, dysfunction, and metabolic changes observed at the studied time when it is over 15% of the body weight. It is assumed that there is the future harm with the use of backpacks with loads up to 15% of the body mass. We also observed that re-education involving the correct way to use the backpack with a load reduction is of great value as an initiative to prevent harm, being the simplest and most effective action. Therefore, we identify the need for studies with a focus on the development of possible lesions and improved preventive and treatment approaches.

Craniotomia descompressiva: análise crítica baseada em relatos de caso / Decompressive cranotomy: critical analysis based on case reports

Entende-se por infarto maligno aquele que acomete mais da metade do território da artéria cerebral média, atingindo níveis de mortalidade de até 80%. A craniotomia descompressiva tem se mostrado como técnica operatória capaz de reduzir significativamente essas taxas. No entanto, persistem na literatura muitas dúvidas quanto à indicação do procedimento relacionadas a idade, hemisfério cerebral acometido, time cirúrgico e status neurológico pré-operatório. Analisamos 10 pacientes vítimas de acidente vascular cerebral (AVC) isquêmicos extensos, tratados no hospital SEMPER-BH, levando-se esses fatores em consideração. Concluímos que a idade e o quadro neurológico prévio ao momento cirúrgico são os dois fatores mais importantes no prognóstico do paciente submetido à craniotomia descompressiva.

It is understood that malignant infarction affects more than half of the middle cerebral artery territory and reaches mortality rates up to 80%. A decompressive craniotomy has been recommended as the surgical technique that can significantly reduce these rates. However, many questions persist in the literature as the indication of the procedure related to age, hemisphere affected, surgical time and preoperative neurological status. We analyzed 10 patients who suffered extensive ischemic stroke treated in hospital SEMPER-BH taking these factors into consideration. We conclude that age and neurological status prior to the surgical time are the two most important factors in the prognosis of patients undergoing decompressive craniotomy.