Ventral Decubitus Research Articles

Importância das variantes anatômicas nasossinusais na avaliação pré-operatória por tomografia computadorizada da cirurgia endonasal

Endonasal surgery is utilized in diagnosis, biopsy, management and follow-up of several sinonasal diseases. In order to perform this procedure with the appropriate safety, preventing iatrogenic lesions, it is essential that the surgeon can preoperatively rely on an appropriate mapping of bone structures involving the nasal fossae, paranasal cavities and their drainage pathways. The imaging method of choice for this evaluation is computed tomography (CT), considered as the golden-standard, based on the evaluation of axial, coronal and sagittal images. Coronal images can be directly acquired, preferentially with the patient in ventral decubitus, or otherwise being reconstructed from axial images. Spiral, and especially multislice CT equipment allow multiplanar image reconstruction with a quality similar to the images directly acquired in the coronal plane, with the advantage of eliminating artifacts originated by eventual dental restorations. Sagittal reconstructions supplement the anatomical detailing of paranasal cavities provided by coronal images, especially of frontal sinuses and frontal recess. Anatomical variations involving the ethmoid sinuses are very frequently found. Earwaker, evaluating 800 patients, has observed 52 types of variations involving the nasal fossae and paranasal cavities, with 93% of patients presenting one or more of these variations. Some of the variations have no clinical significance; however, other should be valorized and described, considering that they may be related to the genesis of sinusopathy or even may affect endonasal

Effects of a program of physical activity on the autonomy level of elderly participants in the program of the family health

Introduction: The objective of this study was to verify the effects of a program of physical activity on the autonomy level of elderly participants of the Program of Family Health. Materials and Methods: The sample was composed by seniors of both sexes, being divided in an experimental group (GE), with mean age of 68.66±5.93 years (n=35), and a control group (GC), with mean age of 69.80±8.05 years (n=35). The functional autonomy was evaluated by the battery of tests of the Group of Latin-American Development for the Maturity (GDLAM), composed of: to walk 10m (C10m), to get up of the seating position (LPS), to get up of the ventral decubitus position (LPDV), to get up of the chair and to move around in the house (LCLC) and the test of to dress and to remove a shirt (VTC). Results: In the pre-test, a weak value of functional autonomy was observed in all the tests, in GE and in GC. After the intervention, it could be noticed in the results of GE a weak value in the LPS test, regular in the LCLC and IG tests and strong in the LPDV, C10m and VTC tests. Discussion: The elderly participants, after the accomplishment of the program of physical activity, obtained improvement in their level of functional autonomy, echoing in a smaller diffi culty for the accomplishment of the activities of the daily life.

Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso

The achondroplasic dwarfism or achondroplasia is the most common form of dwarfism and occurs, in most of the cases, as a result of spontaneous genetic alteration. The anesthesia in these patients presents several particularities. The objective of the present report was to describe an achondroplasic patient case, with a previous history of surgical procedure of the vertebral column for medullar decompression, submitted to haemorrhoidectomy through the bilateral blockade of the pudend nerves. Male patient, 47 years old, achondroplasic, hospitalized to perform hemorrhoidectomy. Upon physical examination, he presented a shortened neck with limited extension of the head, Mallampati class IV, thyromental distance of 6 cm and opening of the mouth of 3.5 cm. The vertebral column presented thoracic kyphosis and severe lumbar lordosis, in addition to a surgical scar in the lumbar region. A bilateral blockade of the pudend nerves was performed with ropivacaine at 1%, via transperineal, with isolated needle measuring 0.8 mm x 100 mm 21G (Stimuplex A100 BBraun, Melsungen, Germany) connected to the peripheral nerve stimulator (Stimuplex-DIG, BBraun).The patient was positioned in ventral decubitus and the surgery started after 15 minutes of anesthetic administration. During the entire procedure, the patient remained conscious and did not report pain or discomfort. Up to the moment his hospital discharge (22 hours after the performance of the blockade), the patient did not mention pain, discomfort, nausea, vomit, motor blockade, urinary retention or incontinence. After his discharge from the hospital, he evolved well presenting evacuation after 31 hours from surgery. The case illustrated the use of the bilateral blockade of the pudend nerves, with the help of the neurostimulator, as an isolated anesthetic techniques for hemorrhoidectomy.

Syndrome de l'artère mésentérique supérieure : une cause à évoquer devant des vomissements isolés chez l'enfant. À propos de 3 observations

Duodenal obstruction by Superior Mesenteric Artery (SMA) is a misdiagnosed vomiting syndrome in children. Several factors are involved, including rapid weight loss, rapid statural growth without weight augmentation. Diagnosis is suspected when an improvement is achieved by ventral decubitus and it is confirmed by plain films of the abdomen, GI study with barium and echography, measuring the aortomesenteric angle (inferior to 25–30°). Patients must at first be treated conservatively. Surgery is indicated for occlusive episodes with unsuccessful conservative therapy. The authors report 3 cases with different clinical presentation. However, all the patients presented important weight loss and vomiting.

Improvements in video-endoscopic sympathicotomy for the treatment of palmar, axillary, facial, and palmar-plantar hyperhidrosis.

Video-endoscopic sympathicotomy for the treatment of palmar, axillary, facial and palmar-plantar hyperhidrosis was modified as to the type of surgical access and the level of incision in the sympathetic chain and communicating rami, depending on the clinical indications. Under general anaesthesia, using a single lumen endotracheal tube, the patient is put in lateral decubitus and pneumothorax is induced. The patient is then placed in ventral decubitus, with the head elevated, to make two punctures in the posterior axillary line, at the level of the 4th and 7th intercostal spaces, to introduce two ports of 5 and 10 mm in size, respectively. The sympathetic chain and the communicating rami are viewed and severed, according to the indications, at different levels to treat palmar, axillary, facial and palmar-plantar hyperhidrosis and combinations of the above. The operation is performed on both sides of the thorax during the same period of anaesthesia. One hundred-forty patients (280 procedures) have been operated on from 1993 to 1997 using this technique. All were operated on as outpatients. Our results are: 100% of those with facial and palmar hyperhidrosis and 96% of those with axillar hyperhidrosis were cured, and 94% with plantar hyperhidrosis were relieved from 50 to 100%, with the follow-up of between one and 47 months.

PERFORATION OF SIGMOID COLON AFTER EXTRACORPOREAL LITHOTRIPSY

A 32-year-old white man presented with an 8 mm. renoureteral calculus on the left side. He was placed in the ventral decubitus position and underwent ESWL with 3,000, 7 kV. shock waves. The patient had symptoms of nephritic colic on the left side and on day 5 after ESWL he complained of indistinct pain in the left iliac fossa along with 6 episodes of diarrhea in 24 hours. Symptoms improved after receiving analgesics but on day 7 significant clinical worsening was characterized by signs of septicemia and an acute abdomen. An x-ray of the abdomen revealed pneumoperitoneum with the right diaphragmatic cupula and bilateral disappearance of the psoas muscle line (fig. 1). With the diagnostic hypothesis of perforative acute abdomen due to the use of antiinflammatory drugs the patient underwent laparotomy. The surgical finding was diffise pustular peritonitis and a blocked 1 cm. perforation in the distal sigmoid colon in the mesocolic margin. No diverticulum or foreign body was identified in the colon or in the cavity. In the distal urethral projection an intense organized inflammatory process was identified. The patient elected resection of the perforated intestinal segment following terminal colostomy of the sigmoid, rectal stump closure, washing of the abdominal cavity and broad-spectrum antibiotic therapy (fig. 2). On pathological examination a perforative process was observed in a segment of the sigmoid with infiltrating polymor

ANNUAL VARIATIONS OF THE SODIUM CHANNEL BLOCKING TOXIN IN VENEZUELAN CATTLE PRONE TO DEVELOP THE BOVINE PARAPLEGIC SYNDROME: ITS DEPENDENCE ON RAIN

A characteristic of the bovine paraplegic syndrome (BPS) is ventral or sternal decubitus in animals that make unsuccessful efforts to stand when stimulated. Death occurs after a few days. In a previous work we showed the existence of a sodium channel blocking toxin (SCBT) produced by ruminal bacteria in cattle with or liable to develop BPS. The presence of SCBT in bovine plasma sampled monthly during the rainy and dry seasons in animals without BPS has now been observed. A positive correlation between rain precipitation and plasma toxin levels (Spearman's rank correlation coefficient=0.457, n=135, p<10 ) was found. Precipitation was 194 (121-289) mm water/month (n= 162 months in 27 years, median and its 95% confidence interval) during the rainy season and 7 (0-35) mm water/month (n=109 months in 28 years) during the dry season [p < 10 , Mann-Whitney (Wilcoxon) test]. Plasma toxin levels were determined by high performance liquid chromatography (HPLC). Toxin levels, expressed as peak units of area (PUA) at 340 nm, (1 PUA = 2.5x10 units of absorbance/cm) were 5.5 (0.0-23.3) PUA/nl (n = 133) in the rainy season and 0.0 (0.0-1.1) PUA/nl in the dry season (n= 88, p=2x10 ). The distribution of toxin concentration in both groups was also different ( test, p=0.024, 7 degrees of freedom). It is then determined that toxin was not detectable in 84.1 % of the cows in the dry season (n = 88) and in only 38.3% of the cows in the rainy season (n = 133) ( test, p<10 ).

Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome.

To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique. The study was completed in the intensive care units of university hospitals as part of the management of the patients studied. Twelve patients (7 males, 5 females, mean age 51.8 +/- 16.6 years) suffering from ARDS of different aetiologies. Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated. A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p < 0.01) was observed between the baseline conditions (mean 123.9 +/- 22.6) and VD (mean 153.0 +/- 16.9), while no statistical significant was noted between baseline conditions and after 10 min of restored DD (mean 141.1 +/- 19.7). A significant increase in Crs (p < 0.001) was observed between baseline conditions (mean 42 +/- 10.1) and VD (mean 48.8 +/- 9.6) and between baseline conditions and restored DD (mean 44.7 +/- 10.6). Two patients were considered nonresponders. All the patients were haemodynamically stable. No side effects were noted. We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.

Ligadura do canal arterial: técnica extrapleural

A técnica de correção cirúrgica da persistência do canal arterial (PCA) com ligadura tripla por via extrapleural é apresentada. Após anestesia geral, a criança é posicionada em decúbito lateral direito tendendo a decúbito ventral. Por uma pequena incisão acompanhando a borda inferior da escápula, o canal arterial é dissecado e ligado duplamente com fios Poliéster 2/0 e um ponto transfixante de Polipropileno 4/0. Essa técnica dispensa drenagem torácica. De setembro de 1988 a agosto de 1990, foram operados 47 pacientes portadores de PCA. Destes, 40 foram submetidos à técnica. A idade variou de quatro meses a 11 anos com média de 3,1 ± 3,0 anos (Tabela 1). Vinte e quatro crianças eram do sexo feminino e 16 do masculino. Vinte crianças (50%) tinham idade menor que um ano. Não foi registrada nenhuma intercorrência intra ou pósoperatória. Todas as crianças foram seguidas no pós-operatório tardio com avaliação clínica, exame radiológico do tórax e ecodopplercardiografia. Nenhuma delas apresentou recanalização ou lesão de nervo recorrente, num seguimento que variou de sete a 30 meses, com média de 15,3 meses. Em nossa experiência, a ligadura do canal arterial mostrou-se benigna quanto ao intra e ao pós-operatório, não apresentando mortalidade imediata ou tardia. Essa técnica deve ser utilizada como de escolha na correção da PCA, principalmente com crianças de baixa idade e peso.

A New Operative Method for Exposing the Seminal Vesicles and Prostate for Extirpation.

Toledo, Ohio, August 2, 1901. <h3>To the Editor:</h3> —Dr. Fuller, in the issue ofThe Journal, July 6, in replying to my letter failed to notice that my contention was with him, and not Zuckerkandl. I know nothing about a Zuckerkandl operation upon the prostate. I have been contesting the claims of Dr. Fuller, trusting that if I showed that my claims and those that he makes were alike, that he would accept his own construction that there is a real difference between the claims of Zuckerkandl and the claims which I made and published in the<i>Medical Record</i>, August 6, 1892. My charge is that Dr. Fuller has changed the position of my patient from the dorsal to the ventral decubitus, after the suggestion of Von Dittel and Kraske, and, in an unimportant way, altered the U-shaped form of my incision through the skin to two horizontal lines along

"A New Operative Method for Exposing the Seminal Vesicles and Prostate for Extirpation."

Toledo, Ohio, June 4, 1901. <h3>To the Editor:</h3> —In the May 4 issue ofThe Journalmy attention has been called to an article by Dr. Eugene Fuller, of New York, on the subject of "A New Operative Method for Exposing the Seminal Vesicles and Prostate for Extirpation." Inasmuch as Dr. Fuller's assumptions are based upon work which originated, so far as I have any definite information, with myself more than nine years ago, and was published in the<i>New York Medical Record</i>, Aug. 6, 1892, I feel that he has done me an injustice to publish a report of "a new method" wherein he describes an operation exactly like my own, with the unimportant change of the patient from the dorsal to the ventral decubitus. Does changing a patient from the dorsal to the ventral position give an operator the right to lay claim to all the work that