Concordancia oftalmólogo-enfermera en la primera exploración postquirúrgica de la cirugía de cataratas / Agreement between ophthalmologist and nurse in the first postoperative exploration following cataract extraction

Introducción: La actividad de enfermería en el proceso quirúrgico de la catarata engloba, desde la realización de la biometría en el preoperatorio y la colaboración en la cirugía, hasta la administración de los primeros cuidados en el postoperatorio y la información al paciente y a la familia durante todo el proceso. El objetivo del presente trabajo es analizar la concordancia entre oftalmólogo y enfermera en los hallazgos de la primera exploración postquirúrgica de los pacientes intervenidos de cataratas mediante facoemulsificación y sin complicaciones en la cirugía. Metodología: El estudio se realizó entre mayo y junio de 2005 en 129 pacientes intervenidos de cataratas, 78 mujeres y 51 hombres con edad media de 73,1 años. Se definieron las variables a valorar en la primera exploración postquirúrgica y se estudió la concordancia entre oftalmólogos y enfermeras en la identificación de las complicaciones más frecuentes de la cirugía de cataratas. Resultados: La concordancia fue del 100% de los casos en la presión intraocular >22 mm de Hg, la irregularidad pupilar, la reacción inflamatoria de cámara anterior y el prolapso de iris; del 65,9% en la presencia de Seidel, y del 60,5% en el edema corneal severo. Conclusiones: El alto índice de concordancia médico-enfermera encontrado en 4 de las variables, puede ofrecer la posibilidad de que la enfermera realice esta primera exploración postquirúrgica. Sin embargo, una concordancia moderada en el resto hace necesario un mayor periodo de formación del personal de enfermería, para conseguir aumentar estos valores (AU)

Introduction: Nursing activity in the cataract extraction process extends from carrying out biometry in the preoperative stage and collaboration in surgery, to providing the initial care in the postoperative stage and keeping the patient and family informed throughout the whole process. This article analyses agreement between ophthalmologists and nurses in the findings of the first post-surgical exploration of patients of cataract extraction using facoemulsification and without complications in surgery. Methods: The study was carried out between May and June of 2005 on 129 patients who had been operated on for cataracts, 78 women and 51 men with an average age of 73.1 years. The variables to be evaluated in the first post-surgical exploration were defined, and a study was made of the agreement between ophthalmologists and nurses in identification of the most frequent complications in cataract surgery. Results: Agreement was 100% in the cases of intraocular pressure >22 mm Hg, pupil irregularity, inflammatory reaction of the anterior chamber and iris prolapse; it was 65.9% on the presence of Seidel; and 60.5% on severe corneal edema. Conclusions: The high rate of agreement between ophthalmologists and nurses in 4 of the variables might offer the possibility of the nurse carrying out this post-surgical exploration. However, a moderate rate of agreement in the other variables makes a longer training period for nursing personnel necessary in order to obtain higher values (AU)

Squamous-cell carcinoma of the lower lip: a retrospective study of 58 patients.

The charts of 58 patients with squamous-cell carcinomas of the lower lip, treated at the General Hospital of the University of São Paulo Medical School from January 1980 to December 1989, were retrospectively analyzed. In addition to regular demographic data, all available information was collected regarding: smoking and drinking habits; sun exposure; clinical stage; macroscopic features of the primary lesions; type of treatment; and follow-up. A meticulous pathological analysis, comprising the histologic differentiation grade, maximal tumor thickness, sun elastosis, perineural spread, vascular and muscular invasion, surgical margins, peritumoral inflammatory infiltrate, and positive lymph nodes, with or without extracapsular spread, was undertaken as well. The evaluation of the overall 5-year survival showed significant statistical differences, with prognostic implications, for the following variables: maximal tumor thickness, T-stage and positive nodes.

Ocorrência da forma mucosa de leishmaniose tegumentar em cäes na regiäo do Vale do Ribeira, Estado de Säo Paulo, Brasil; resumo

Em cäes, nenhuma mençäo foi feita quanto à presença de manifestaçäo da forma mucosa. Recentemente, algumas famílias se instalaram numa área piloto de estudos epidemiológicos sobre leishmaniose tegumentar no Município de Miracatu, Estado de Säo Paulo, e, juntamente com esses indivíduos, varios cäes foram também incorporados às pesquisas em desenvolvimento. No cadastramento e exame dos novos componentes foi possível observar macroscópicamente a presença de cäes portadores de lesöes com aspecto de ulceraçöes nasais, pequenas lesöes em orelhas, escoriaçöes peladas e unhas longas. Desse modo, os animais suspeitos foram submetidos a diagnóstico com base em métodos de pesquisa de leishmania, tanto em pele íntegra como em lesöes, através do exame parasitológico direto, tentativa de isolamento em cultura e hamster; exame histopatológico; teste de imunofluorescência indireta (IFI); determinaçäo da procedência do animal e tempo de permanência na regiäo. Com essa metodologia consideraram-se 3 cäes com ulceraçöes nasais como portadores da infecçäo leishmaniótica. Sabemos que, devido ao caráter acidental desse encontro, näo é fácil interpretar esse resultado; contudo, há necessidade de se investigar a extensäo do problema e analisá-lo a luz das pesquisas realizadas em área de ocorrência de L. braziliensis e de flebotomíneos vetores. Portanto, precisa-se conhecer o significado epidemiológico da infecçäo canina, particularmente em área onde a doença assume feiçöes domiciliares como é o caso do Vale do Ribeira