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ABSTRACT Objective Determining the etiology of hyperprolactinemia is fundamental for selecting the most appropriate treatment strategy. The aim of this study was to evaluate the usefulness and accuracy of prolactin levels in predicting the etiology of nonphysiological hyperprolactinemia. Subjects and methods In this retrospective study, we reviewed medical records of patients with nonphysiological hyperprolactinemia seen at two neuroendocrine reference centers located in Recife, Brazil, from January 2000 to December 2019. Results The study included 770 patients aged 12-73 years (65% female). The three most frequent etiologies of hyperprolactinemia were prolactinomas (n = 263; 34.2%), drug-induced hyperprolactinemia (n = 160; 20.8%), and macroprolactinemia (n = 120; 15.6%). The highest mean prolactin levels were observed in cases of prolactinomas and idiopathic hyperprolactinemia. Most patients with hyperprolactinemia due to other etiologies had prolactin levels < 100 ng/mL, but these levels were also found in 16.5% of patients with microproplactinomas and in 20% of those with idiopathic hyperprolactinemia. Likewise, prolactin levels largely overlapped among patients with microprolactinomas, macroprolactinemia, and drug-induced hyperprolactinemia. Notably, prolactin levels > 250 ng/mL enabled a clear distinction between the etiologies of macroprolactinoma and nonfunctioning pituitary adenoma. Moreover, prolactin levels > 500 ng/mL were highly suggestive of macroprolactinomas, although they were also found in very few patients ( 250 ng/mL allowed a clear distinction between macroprolactinomas and nonfunctioning pituitary adenomas. Furthermore, prolactin levels > 500 ng/mL were almost exclusively found in patients with prolactinomas.

Application of tetramethylammonium hydroxide for the treatment of samples prior to elemental analysis over the last five years is approached in this review article. Characteristics and properties of this reagent are described for a better understanding of the treatment process. Its effect on analyte measurements performed by atomic spectrometry techniques (flame and graphite furnace atomic absorption spectrometry, atomic fluorescence spectrometry, inductively coupled plasma optical emission spectrometry and, inductively coupled plasma mass spectrometry) is discussed, mainly the possibilities of physical interferences. Ways of using the reagent in sample preparation, such as incubation at room temperature, use of ultrasound energy, microwave energy, among others, will be discussed, in addition to the use of the reagent in speciation and nanoparticles analyses. Tetramethylammonium hydroxide has proven to be a viable alternative in the treatment of samples that can improve the performance of methods based on atomic spectrometry in the determination of elements of great interest to society.

SUMARIO: 1. INTRODUCCIÓN: DELIMITACIÓN, TIPOLOGÍA Y RELEVANCIA SISTÉMICA.—2. LAS RELACIONES DE COLABORACIÓN: 2.1. Aproximación: definición y caracterización general; 2.2. Los principios que rigen las relaciones de colaboración; 2.3. La tipología de las relaciones de colaboración: 2.3.1. Las relaciones de auxilio y asistencia; 2.3.2. Las relaciones de cooperación; 2.3.3. Las relaciones de coordinación; 2.4. Los instrumentos técnicos a través de los cuales se canalizan las relaciones de colaboración: 2.4.1. Instrumentos de colaboración de naturaleza funcional; 2.4.2. Instrumentos de colaboración de naturaleza orgánica.—3. LAS RELACIONES DE CONTROL: 3.1. Aproximación: caracterización general y tipología; 3.2. Las relaciones de control entre la Administración General del Estado y las Administraciones generales de las comunidades autónomas; 3.3. Las relaciones de control entre la Administración General del Estado/Administraciones generales de las comunidades autónomas y las entidades locales.—4. LAS RELACIONES DE CONFLICTO: 4.1. Aproximación: caracterización general y taxonomía; 4.2. Las relaciones de conflicto entre la Administración General del Estado y las Administraciones generales de las comunidades autónomas o entre las Administraciones generales de las comunidades autónomas; 4.3. Las relaciones de conflicto entre la Administración General del Estado/Administraciones generales de las comunidades autónomas y las entidades locales; 4.4. Las relaciones de conflicto entre Entidades locales.—5. BIBLIOGRAFÍA: 5.1. Bibliografía citada; 5.2. Bibliografía recomendada.

El tratar de dar soluciones adecuadas a la problemática específica de los municipios con escasa población y recursos exige que se establezca un régimen jurídico especial para estos. Dicho ordenamiento ha de basarse, entre otros, en los principios de adecuación y diferenciación, y abarcar múltiples materias como: la organización, las competencias, la financiación, la contratación, los procedimientos administrativos, etc. La responsabilidad de articular tal regulación es compartida entre el legislador básico estatal y de desarrollo autonómico.

Objective: Evaluate the treatment of hallux valgus through percutaneous surgery. Methods: This is a systematic review, and the search was conducted on PubMed/Medline and Virtual Health Library (VHL) databases. The search included studies that addressed percutaneous surgery and analyzed the American Orthopaedic Foot & Ankle Society (AOFAS) score, published between 2013 and 2018, as original studies, in English, Portuguese and Spanish. Results: One-hundred and eighty-five articles were identified in the databases, 19 were selected for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) application, and five were included in the systematic review. The majority of the studies were European; the age of the patient was from 17 to 78 years, who suffered from mild to severe deformities, which were evaluated radiographically and through the AOFAS scale, then submitted to minimally invasive surgeries. Postoperative follow-up was from six months to ten years. Conclusion: The percutaneous technique for hallux valgus correction has shown good results, little surgical trauma, few complications, rapid recovery, return to activities and high satisfaction with the result. Level of Evidence I; Systematic Review of Level I Studies.

Background: Cervical cancer (CC) is the fourth leading cause of cancer among women in the world. Metabolomics can provide a deeper understanding of the underlying metabolic alterations associated with its pathophysiology. Objective: To systematically analyze metabolomic approaches and findings used in the study of cervical cancer. Selection Criteria: Studies that included the use of metabolomics, obtained through biological samples, from patients diagnosed with CC. Data collection and Analysis: The review was conducted according to the PRISMA guidelines, and registered in PROSPERO. The terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to “Metabolomics” and “Cervical Cancer” were used as descriptors. Article quality was reviewed based on the QUADOMICS criteria. Results: A total of 17 articles were selected for systematic review. Study quality evaluation using QUADOMICS demonstrated heterogeneous results. The main changes in metabolite levels associated with cervical cancer were identified in alanine, creatine, valine, tyrosine, isoleucine, phosphatidylcholine, acetate, lactate and β-glucose. Some amino acid levels were reduced in patients with CC and changes in energy metabolism pathways were observed. Eight articles tested the diagnostic capacity of metabolomics, obtaining results for sensitivity > 90%, specificity between 73% and 99% and AUC between 0.78 and 0.99. Conclusion: The results suggest that patients with CC present alterations in energy metabolism, amino acids and glycerolphospholipids, pointing to a potential group of specific biomarkers.

The transformations resulting from industry 4.0 also impacted agriculture, being designated as Agriculture 4.0, responsible for using monitoring technologies in plantations. However, family farming still does not exhibit the usage of existing technologies, therefore, the present work proposed to study the field of agriculture 4.0 in Brazil and the circumstances of family farmers, with the purpose of developing a device capable of introducing principles of agriculture 4.0 in such properties. The project included the elaboration of a literary survey, centered on startups, industry and agriculture, together with a questionnaire directed to family farmers, responsible for collecting 10 responses and pointing out the small contact that the participants have with agriculture 4.0, and finally the development of a prototype, capable of measuring air temperature and humidity and soil moisture near a plant, the device has not yet been subjected to field tests, but it shows promise in its performance under real conditions.

The objective of this study was to monitor the training loads (TL) and well-being of elite rhythmic gymnastics (RG) athletes, as well as compare these variables between starters and reserve gymnasts during 25 weeks of training. Ten athletes from the Brazilian national RG team (17.4 ± 1.1 y of age) were monitored during the general preparatory period (GPP), specific preparatory period (SPP), and pre-competitive period (PCP). The internal TL was quantified with the use of sessional ratings of perceived exertion (sRPE). We assessed well-being daily with a well-being scale. The TL, duration, monotony, and strain were calculated weekly. We found that the internal TL and session durations were 9242 ± 2511 AU and 2014 ± 450 min, respectively. The internal TL, strain, and monotony were greater in the PCP than in the GPP and SPP for starters. In the SPP, there were statistical differences in internal TL (p = 0.036) and strain (p = 0.027) between starters and reserves. In the PCP, there were also statistical differences between starters vs. reserves athletes regarding internal TL (p = 0.027) and strain (p = 0.05). There was no statistically significant difference in well-being between the periods assessed. In conclusion, RG athletes display a higher TL magnitude during the PCP, whereas only reporting non-significant minor variations in well-being. In addition, there is a discrepancy in the TL between starters and reserves.

Abstract Objective To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears.

Do ponto de vista demográfico, o século XX, começo do Antropoceno, caracterizou-se, entre outros fatores, pelo envelhecimento social, e pela consolidação de um incontrolável processo de concentração da população nas cidades. Assim, de acordo com os dados e as estimativas fornecidas pela ONU-HÁBITAT, em 1950, apenas um terço da população mundial vivia em cidades, ao passo que no ano 2000 esse percentual aumentou para a metade e prevê-se que em mais 50 anos dois terços da humanidade venham a residir em grandes cidades. Trata-se, por conseguinte, de um fenômeno complexo que apresenta um perfil duplo. Um lado agradável, o “processo de urbanização”, que consiste na progressiva aglutinação das pessoas e de suas atividades econômicas nas cidades, centros de inovação e de progresso. E um lado amargo, o “processo de esvaziamento rural”, que pode ser definido como a perda maciça e acelerada de habitantes das zonas não urbanizadas por causas socioeconômicas (emigração) e naturais (envelhecimento e morte), com a consequente deterioração da coesão social e da capacidade nacional de autoabastecimento de alimentos, e, em consequência, a dependência do exterior pela importação destes

Abstract Mucopolysaccharidoses (MPS) are inborn errors of metabolism caused by deficient lysosomal enzymes, leading to organomegaly, hip osteonecrosis, coarse facial features, bone deformities, joint stiffness, cardiac and pulmonary symptoms (MPS VI) or hypermobility (MPS IVA). Some patients may present with non-classical forms of the disease in which osteoarticular abnormalities are the initial symptoms of non-classical forms. As orthopedists and surgeons are the specialists most frequently consulted before the diagnosis, it is critical that MPS may be considered as a differential diagnosis for patients with bone dysplasia. Experts in Latin America reviewed medical records focusing on disease onset, first symptoms and the follow-up clinical and surgical outcomes of non-classical MPS VI and IVA patients. All patients displayed orthopedic issues, which worsened over time, followed by cardiac and ophthalmological abnormalities. Our findings enlighten the necessity of including non-classical MPS as possible diagnosis for patients who report osteoarticular abnormalities in absence of inflammation.

ABSTRACT Objective: To verify the impact of avascular necrosis of the femoral head on the quality of life of children and adolescents with Perthes disease and sickle cell disease. Methods: A comparative study including 24 children between eight and 18 years old with avascular necrosis of the femoral head secondary to Perthes disease and sickle cell disease (Group with Necrosis) and 24 children considered asymptomatic (Group without Necrosis). Clinical and sociodemographic data were collected and the PedsQL 4.0 and the Charnley score for hip dysfunction were applied. Results: There was no difference in the overall score and in any domain when comparing the Perthes group (global = 73.1) and the sickle cell disease group (global = 65.9). When comparing the groups with necrosis and without necrosis, the Perthes group had a lower overall score only for the Physical Functioning domain (87.5 versus 68.5); sickle cell disease group had a lower overall score (64.9 versus 79.4) and in the Physical Functioning (68.5 versus 87.5) and School Functioning (62.9 versus 73.7) domains. Conclusion: Avascular necrosis of the femoral head produces lower quality of life scores both in the global evaluation and in the domains Physical Functioning and School Functioning. Necrosis, bilateral lesion, and hip function were found to be associated with the loss of quality of life. Level of Evidence III, Sectional comparative study.

This paper presents a new linear state estimation model based on a current summation load flow method for three-phase distribution systems. The developed estimator may be applied to both the supervision of distribution systems under normal operating conditions and the fault location in cases of low and high impedance faults. Our studies were conducted using a real distribution feeder. For fault location analysis, the system was modeled using the ATP (alternative transient program) in order to emulate measurements of voltages and currents at the substation, and voltage magnitudes registered by other meters during the fault. We used the MATLAB™ software to process the algorithms. The main contributions that arose after integrating the current method into system supervision in case of network failures under normal operating conditions and the fault location are as follows: (i) estimation of system losses; (ii) modeling of loads in real time to consider their contributions in the fault location process; and (iii) low influence of fault resistance in the location algorithm. The results show that the proposed method has good precision, low computational processing time, and is promising for distribution system supervision with a reduced number of meters.

O trabalho em unidade de terapia intensiva (UTI) pode ser considerado um dos mais estressantes para o médico e a relação entre este trabalho e o burnout ainda é pouco estudada. Realizou-se revisão sistemática com o objetivo de descrever a produção científica sobre a prevalência e os fatores associados ao burnout em médicos intensivistas, publicados nas bases de dados: IBECS, LILACS, MEDLINE, Psyc Info, PubMed e Scielo. Os critérios de inclusão foram estudos originais, com delineamento transversal, que utilizaram o Maslach Burnout Inventory (MBI) em médicos intensivistas. A busca identificou 118 artigos e destes, 09 artigos foram elegíveis. A segunda década dos anos 2000 teve a maior concentração de artigos e cinco publicações foram realizadas no Brasil, o que pode significar um incremento na produção científica nacional sobre o tema. Os resultados dos estudos que utilizaram como critério diagnóstico o nível alto em pelo menos uma dimensão da síndrome, apontaram elevada prevalência de burnout. Observou-se também uma diversidade de fatores associados a prevalência de burnout. Constatou-se uma heterogeneidade de critérios para identificação da síndrome e de formas de cálculo e de interpretação dos resultados do MBI. Sugere-se a padronização dos critérios para identificação da síndrome, dos cálculos e da interpretação dos resultados do MBI.

ABSTRACTOBJECTIVE: To assess the quality of life of knee osteoarthritis patients using the SF-36 questionnaireMETHODS: Cross-sec-tional study with 93 knee osteoarthritis patients. The sample was categorized according to Ahlbӓck score. All individuals were interviewed with the SF-36 questionnaireRESULTS: The main finding of the study is related to the association of edu-cation level with the functional capacity, functional limitation and pain. Patients with higher education level had better functional capacity when they were compared to patients with basic level of educationCONCLUSION: Individuals with osteoarthritis have a low perception of their quality of life in functional capacity, functional limitation and pain. There is a strong association between low level of education and low perception of quality of life. Level of Evidence IV, Clinical Case Series.

The objective of this article is analysing to what extent Law 27/2013, of December 27, on the Rationalisation and Sustainability of the Local Administration has a direct influence on sectorial state regulation and on regional regulations, whether statutory or ordinary, local or sectorial, in the fields of education, healthcare, health and social services. To that end, the article first of all expounds, in a detailed way, the variations that the cited law aims to introduce in the powers of Spain’s Local Councils, by modifying the 2nd and 3rd sections of Article 25 of the LBRL and adding the 4th and 5th paragraphs to it, and also by means of the Additional Fifteenth and Provisional First, Second and Third Dispositions; secondly, it examines not only the constitutional viability of the limitation and conditioning of the system for attributing powers to Municipalities, which the cited Law includes in the aforementioned Article 25, but also the legitimacy and possible scope –both legally and in practice– of the intention to transfer certain functions, in the indicated fields, from Municipalities to Autonomous Regions, in accordance with the new regulatory basis.

ABSTRACT Objective: To analyze the incidence of spinal injuries between 2000-2010 due to motorcycle accidents and the relation to the increase in motorcycle sales in the same period, as well as the anatomical distribution of these spinal injuries. Methods: Data were collected from 1,295 records of patients who have suffered spinal injury resulting from motorcycle accidents admitted to the ward TRM (Spinal Cord Trauma) of the Hospital Geral do Estado da Bahia from 2000 to 2010 in this retrospective study. We selected 110 medical records and collected information on sex, age, neurological deficit on admission (according to Frankel scale), diagnosis, and level of injury. Results: Between 2000 and 2010 there was an increase of almost five times in the incidence of patients who have suffered spinal injury due to motorcycle accidents. More than half (51.4%) had cervical spine injury, 37.2% thoracic spine injury and 11.34% had lumbar spine injury. Only 34.3% of patients had no neurological deficit on admission and patients with thoracic spine fracture had a higher incidence and severity of lesion. The average age of patients was 30 years. Conclusions: The increased incidence of spinal injuries due motorcycle accidents occurred in the same period in which there was an increase in motorcycle sales in the country. Patients who have suffered those injuries were young, with higher incidence in the cervical and thoracic spinal levels and high rates of neurological deficit.

Objective:To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors.Methods:This was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design.Results:31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients.Conclusion:The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

OBJECTIVE: To assess socio-demographic characteristics of individuals that suffered open fractures caused by motorcycle traffic accident and evaluate infection rate in search of associated risk factors. METHODS: A retrospective study comprising 81 patients with open fractures caused by motorcycle accidents was carried out. Clinic and socio-demographic features were collected from patients' records. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. RESULTS: Patients were mostly young adults (mean 32.9 years old), of the masculine gender (83.9%), single (60.5%), from the country side (40.7%), mostly presenting tibial open fractures (48.2%). Fractures type IIIA and type IIIB were the most prevalent lesions (68,8%), and soft tissue damage graded as I and II were the most frequent (64.62%). Infection was present in 23.7% of the patients and it was associated to age higher than 40 years old (p=0.011), to time delay from trauma to first surgical procedure longer than 24 hours (p=0,012), and also to soft tissue damage extent (p=0.001). CONCLUSIONS: Patients with open fractures caused by motorcycle traffic accident were mostly young single men, coming from the state capital and presented severe tibial open fractures, which 23.7% of the cases progressed to infection. Level of Evidence III, Retrospective Comparative Study.

Osteoarthritis (OA) is the most common joint disease in both humans and animals, and it results in movement restriction and pain at the affected area. This disorder affects more than 25% of people over 60 years of age, and it is considered universal for 70-year-old people. OA is estimated to affect over 20% of the canine population from the United States of America. The present study aimed to evaluate the treatment of rats that were surgically induced to OA using two different drug therapies, one with pentosan polysulfate, one with betamethasone, and one with chondroitin sulfate/ glucosamine. In order to produce joint disease, the cranial cruciate ligament was surgically transected. Animals were kept and treated for eight days after surgery and were assessed via both radiographies and tomographies taken before surgery and eight weeks later. All animals were euthanized having both macroscopic and microscopic analysis performed to evaluate the disorder progression and therapeutic action. Macroscopic analysis showed lesion in the knees subjected to OA induction. The untreated animals presented major lesions whereas the treated ones presented mild to moderate lesions. In conclusion, pentosan polysulfate is recommendable for the treatment of iatrogenic joint lesions in rats since the other treatments showed no significant difference. A osteoartrite (OA) é a doença articular mais comum em humanos e animais, o que ocasiona restrição de movimentos e dor, na região acometida. Tal enfermidade afeta mais de 25% dos humanos acima de 60 anos e, aos 70 anos, ela é considerada universal. Estima-se que nos Estados Unidos da América, 20% ou mais da população canina é acometida pela OA. O presente estudo tem como finalidade avaliar a terapia medicamentosa (polisulfato de pentosano, betametasona e sulfato de condroitina/glucosamina), em um modelo experimental de OA cirurgicamente induzido, em ratos. A doença articular foi promovida pela transecção cirúrgica do ligamento cruzado cranial, sendo que, após o procedimento cirúrgico, os animais foram mantidos e tratados por oito semanas. Foi realizada avaliação radiográfica e tomográfica antes e oito semanas após a indução da osteoartrite. Todos os animais foram submetidos à eutanásia para análise macroscópica e microscópica, que foram realizadas para avaliar a progressão da enfermidade e a ação terapêutica. Na análise macroscópica foi observadas lesões nos joelhos submetidos à indução OA. Os animais não tratados apresentaram lesões graves enquanto que, os animais tratados apresentaram lesões leves a moderadas. Concluiu-se que o polissulfato de pentosano é eficiente no tratamento de lesões articulares iatrogênicas de ratos, uma vez que outros tratamentos não mostraram qualquer diferença significativa.

OBJETIVO: Avaliar o gasto energético na marcha em pacientes com mucopolissacaridose, utilizando uma metodologia simples e aplicável ao ambiente clínico. MÉTODOS: Realizou-se estudo transversal comparando-se o gasto energético da marcha de 19 pacientes portadores de mucopolissacaridose (Grupo MPS) com 19 indivíduos assintomáticos da comunidade (Grupo Comparação). O gasto energético foi mensurado em Cal por um relógio da marca Polar (modelo FT7) durante uma caminhada de 50 metros. Foram também avaliados idade, peso, altura, IMC, frequência cardíaca inicial, frequência cardíaca final, e tempo de marcha. RESULTADOS: O Grupo MPS teve gasto energético na marcha de 2,84 Cal(±1,01), versus 1,42 Cal(±0,51), sendo 100% maior que o Grupo Comparação; também em relação ao Grupo Comparação, o Grupo MPS teve frequência cardíaca inicial 22% maior, frequência cardíaca final 13% e tempo da caminhada 25% maiores. CONCLUSÕES: O gasto energético na marcha de pacientes com mucopolissacaridose é duas vezes mais alto em comparação com indivíduos assintomáticos e a metodologia usada para avaliação mostrou-se alternativa eficiente para o ambiente clínico convencional. Nível de Evidencia III, Estudo Transversal Comparativo.OBJECTIVE: The aim of this study is to evaluate energy expenditure during gait in patients with mucopolysaccharidosis using a simple methodology applicable to the clinical setting. METHODS: A cross-sectional study was carried out comparing energy expenditure during gait in 19 patients with mucopolysaccharidosis (MPS Group) with 19 control individuals from the community (Comparison Group). Energy expenditure was measured in calories using a Polar telemetric watch (model FT7) in a 50-meters walking. Variables such as age, weight, height, BMI, initial hart rate, final hart rate, and gait time were recorded. RESULTS: MPS Group showed an expenditure during gait of 2.84 Cal (± 1.01) versus 1.42 Cal (± 0.51), being 100% higher than the Comparison Group; MPS Group had also increased initial hart rate (22% higher), final hart rate (13% higher), and time waking (13% faster). CONCLUSIONS: Energy expenditure during gait in MPS patients was twice higher compared to control individuals and the methodology for evaluation proved an efficient alternative to conventional clinical setting. Evidence Level III, Crosssectional Comparative Study.

JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.JUSTIFICATIVA Y OBJETIVOS: Las cirugías artroscópicas del hombro cursan con un intenso dolor postoperatorio. Diversas técnicas analgésicas han sido preconizadas. El objetivo de este estudio fue comparar el bloqueo de los nervios supraescapular y axilar en las cirugías artroscópicas de hombro con el abordaje interescalénico del plexo braquial. MÉTODO: Sesenta y ocho pacientes fueron ubicados en dos grupos de 34, de acuerdo con la técnica utilizada: grupo Interescalénico (GI) y grupo selectivo (GS), siendo ambos abordajes realizados con neuroestimulador. En el GI, y después de la respuesta motora adecuada, se inyectaron 30 mL de levopubivacaina en exceso enantiomérico de un 50% al 0,33% con adrenalina 1:200.000. En el GS, y después de la respuesta motora del nervio supraescapular y axilar, se inyectaron 15 mL de la misma sustancia en cada nervio. Enseguida se realizó la anestesia general. Las variables que se evaluaron fueron: tiempo para la realización de los bloqueos, analgesia, consumo de opioide, bloqueo motor, estabilidad cardiocirculatoria, satisfacción y aceptabilidad por parte del paciente. RESULTADOS: El tiempo para la ejecución del bloqueo interescalénico fue significativamente menor que para la realización del bloqueo selectivo. La analgesia fue significativamente mayor en el postoperatorio inmediato en el GI y en el postoperatorio tardío en el GS. El consumo de morfina fue significativamente mayor en la primera hora en el GS. El bloqueo motor fue significativamente menor en el GS. La estabilidad cardiocirculatoria, satisfacción y aceptabilidad de la técnica por el paciente no fueron diferentes entre los grupos. Ocurrió un fallo en el GI y dos en el GS. CONCLUSIONES: Ambas técnicas son seguras y eficaces con el mismo grado de satisfacción y de aceptabilidad. El bloqueo selectivo de ambos nervios presentó una analgesia satisfactoria, con la ventaja de proporcionar un bloqueo motor restringido al hombro.BACKGROUND AND OBJECTIVE: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. METHODS: According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n = 34) and selective group (SG, n = 34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30 mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15 mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. RESULTS: Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). CONCLUSIONS: Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder.

Background and objective: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. Methods: According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n = 34) and selective group (SG, n = 34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30 mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15 mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. Results: Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). Conclusions: Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder. Keywords: Anesthesia, Conduction, Anesthetics, Local/levobupivacaine, Brachial Plexus, Orthopedic Procedures, Shoulder Joint

OBJETIVO: Realizar um levantamento epidemiológico das fraturas da coluna vertebral. MÉTODOS: Estudo de revisão de prontuário, retrospectivo analisando dados clínicos e epidemiológicos no período de 1991 a 2010. Foram avaliados dados como: idade, sexo, procedência, escala de Frankel admissional, mecanismo de trauma, tipo de fratura, tratamento e complicações, nos prontuários de 1.917 pacientes submetidos a tratamento de fraturas da coluna vertebral. O teste do qui-quadrado foi utilizado para comparação entre as variáveis discretas e o teste t Student foi utilizado no caso de variáveis contínuas, adotando níveis de significância de p < 0,05. RESULTADOS: A maioria dos pacientes era do gênero masculino (85,2%), média de idade de 34 anos, procedência urbana (69,2%), sendo o mecanismo de trauma a queda de altura (40,4%). Quando a causa for mergulho em águas rasas, está associada a lesões na região cervical, pacientes mais jovens e tende a produzir déficit neurológico. As fraturas isoladas aconteceram em 75,6% dos casos, afetando mais o nível L1 (11,4%), sendo que o tratamento cirúrgico foi indicado em 88,2%, sem complicações pós-operatórias na maioria dos casos (61,7%). CONCLUSÃO: Os autores sugerem mudanças principalmente na área habitacional, com campanhas educacionais preventivas e orientações para jovens que gostam de fazer atividades recreativas como mergulho em água rasa.OBJETIVO: Hacer un estudio epidemiológico de las fracturas de la columna vertebral. MÉTODOS: Estudio de revisión de la ficha médica, retrospectivo, analizando los datos clínicos y epidemiológicos desde 1991 hasta 2010.Se evaluaron datos como la edad, el sexo, el origen, la escala de admisión de Frankel, el mecanismo del trauma, el tipo de fractura, tratamiento y complicaciones en los registros médicos de 1.917 pacientes tratados por fracturas de la columna vertebral. Se utilizó la prueba de chi-cuadrado para comparar las variables categóricas y la prueba t de Student fue utilizada en el caso de las variables continuas, adoptando un nivel de significación p OBJECTIVE: To conduct an epidemiological survey of fractures of the spine. METHODS: We conducted a chart review retrospective study, analyzing clinical and epidemiological data from 1991 to 2010. The evaluated data were age, sex, origin, Frankel scale at admission, injury mechanism, fracture type, treatment and complications in the medical records of 1,917 patients treated for fractures of the spine. The chi-square test was used to compare discrete variables and Student t test was used in the case of continuous variables, adopting a significance level of p

A osteotomia supracondilar varizante do fêmur é o procedimento estabelecido para tratamento do joelho doloroso com artrose lateral e deformidade em valgo. Na descrição das técnicas cirúrgicas convencionais, há divergência com respeito ao local, via de acesso, grau de correção, tipo de fixação e região para colocação da síntese, sendo mais evidente nos casos graves de valgo com angulações acima de 30˚e deformação do fêmur distal associada à hipoplasia do côndilo lateral. Os autores descrevem uma nova técnica cirúrgica de osteotomia femoral distal, baseada em critérios anatômicos e geométricos, desenvolvida no próprio serviço para o tratamento de casos graves de valgo, apresentando um dos casos tratados. A nova técnica consiste em que a cunha a ser ressecada no ato operatório tem direção oblíqua e formato de um triângulo isósceles. A nova proposta para estes casos pretende, então, resolver os problemas apresentados, trazendo a correção do valgo sem causar uma nova deformidade do fêmur distal. É promovido um bom contato ósseo cortical, além de facilitar a aplicação de um sistema estável de síntese. Entretanto, ainda não se tem ideia dos limites de idade do paciente e do grau de artrose do joelho que possam contraindicar esta cirurgia, necessitando, portanto, de maior casuística e tempo de acompanhamento dos casos operados.Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30º and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on anatomical and geometrical criteria, which was developed in their clinic for treating severe valgus cases, and they present one of the cases treated. In the new technique, the wedge to be surgically resected has an oblique direction and the format of an isosceles triangle. This new proposal thus seeks to resolve problems that have been presented in such cases, through enabling valgus correction without causing any new deformity of the distal femur. Good cortical bone contact is promoted, and application of a stable synthesis system is made easier. However, the age limits for such patients and the degree of knee arthrosis that might contraindicate this procedure remain unknown. Hence, a larger sample and longer follow-up for operated cases are required.

Os paragangliomas são tumores neuroendócrinos raros com origem em células especializadas derivadas da crista neural, acometendo a região da carótida ou jugulotimpânica. São raros dentro do canal vertebral, e quando ocorrem são normalmente encontrados no compartimento intradural e extramedular da região lombossacra. Este relato apresenta o caso de um paciente de 26 anos, sexo masculino, com diagnóstico de fratura patológica da coluna torácica (T10), secundária a paraganglioma, causando lesão medular completa. Foi realizado tratamento cirúrgico no Hospital Geral do Estado da Bahia, que apresentou sangramento excessivo como complicação que indicou necessidade de embolização prévia. Com isso, os autores recomendam cautela ao avaliar e tratar esta rara lesão causadora de déficit neurológico, cujo planejamento cirúrgico deve ser criterioso a fim de evitar complicações catastróficas.Paragangliomas are rare neuroendocrine tumors that originate in specialized cells derived from neural crest cells, affecting the region of the carotid or jugular-tympanic artery. They are rare within the spinal canal and, when they occur, they are normally found in the extramedullary intradural compartment of the lumbosacral region. This report presents the case of a 26-year-old male patient who was diagnosed with pathological fracture of the thoracic spine (T10), secondary to paraganglioma, thus causing complete spinal cord injury. Surgical treatment was performed at the General Hospital of the State of Bahia and the complication of excessive bleeding occurred, which indicated that there had been a need for prior embolization. Because of this, the authors recommend caution when evaluating and treating this rare lesion that causes neurological deficits, with careful surgical planning in order to catastrophic complications.

OBJETIVO: Anestesia espinhal é um procedimento seguro e bem documentado para artroscopia do joelho; entretanto, custo maior e algumas complicações têm sido relatados. Por outro lado muitos ortopedistas são relutantes ao uso de anestesia local pelo receio de conversão para anestesia geral ou controle inadequado da dor. O propósito deste trabalho é comparar a anestesia local com anestesia espinhal em dois grupos de pacientes submetidos à artroscopia do joelho. MÉTODOS: Sessenta e cinco pacientes foram divididos em dois grupos, a depender do método de anestesia utilizado, e submetidos à mesma rotina cirúrgica e protocolo de analgesia pós-operatória, sendo avaliados quanto à analgesia, nível de dor no pós-operatório e aceitabilidade da modalidade anestésica. RESULTADOS: Os dois grupos não apresentaram diferenças significativas quanto à analgesia perioperatória e dor no primeiro dia pós-operatório, não diferiram também quanto ao estado emocional. Houve diferença significante quanto à aceitação do procedimento, sendo que 100% aceitariam novamente no grupo de anestesia local contra 60,5% no grupo de anestesia espinha; também 100% no grupo anestesia local contra 67,7% no grupo de anestesia espinhal referiram sentirem-se encorajados pelo tipo de anestesia. CONCLUSÃO: Conclui-se que a anestesia local assemelha-se à anestesia espinhal em quase todos os aspectos, exceto quanto à sua maior aceitação e encorajamento do paciente em realizar o procedimento. A anestesia local pode ser boa opção aos bloqueios raquidianos, especialmente em hospitais-dia, e quando existe restrição por parte dos pacientes aos modelos tradicionais de anestesia.OBJECTIVE: Spinal anesthesia for knee arthroscopy is a well-documented and safe procedure. However, some complications and higher costs have been reported. Also, many orthopaedic surgeons are reluctant to use local anesthesia for fear of having to convert to general anesthesia due to inadequate pain control. The purpose of this study is to compare local with spinal anesthesia in two groups of patients submitted to knee arthroscopy. METHODS: Sixty-five patients were divided in two groups; based on the anesthesia method used, and submitted to the same surgical routine and postoperative analgesia protocol. Resulto: They were evaluated for analgesia, level of postoperative pain, and level of satisfaction with the type of anesthetic. The two groups did not present any significant differences in relation to perioperative analgesia and pain on the first postoperative day, neither was there any difference in relation to emotional state. However, there was a significant difference in terms of acceptance of the procedure; 100% said they would accept the procedure again in the local anesthesia group, compared with 60.5% in the spinal anesthesia group; also, 100% in the local anesthesia group said they felt encouraged by the type of anesthesia, compared with 67.7% in the spinal anesthesia group. CONCLUSION: We can conclude that local anesthesia is similar to spinal anesthesia in almost all the aspects investigated, except in terms of acceptance and patients' level of satisfaction with the procedure. Local anesthesia can be a good alternative to spinal anesthesia, especially in outpatient departments, or when patients have restrictions to traditional models of anesthesia.

OBJETIVO: Por meio de ensaios biomecânicos, comparar as capsulorrafias com sutura simples e com âncoras, em quadris de coelhos. MÉTODO: Foram utilizados 13 coelhos, 26 quadris, todos machos da raça Nova Zelândia albinos (Oryctolaguscuniculus). Inicialmente, realizamos um projeto piloto em três coelhos (seis quadris). Este experimento constou de 10 coelhos, divididos em 2 grupos: o Grupo 1 submetido à capsulorrafia (quadris direito e esquerdo) com sutura simples utilizando fio absorvível de ácido poliglicólico e o Grupo 2 submetido a capsulorrafia (quadris direito e esquerdo) com âncora de titânio. Após o período de quatro semanas de operados, todos animais foram submetidos à eutanásia e seus quadris congelados. Após um descongelamento prévio das peças, no mesmo dia das análises biomecânicas, foram avaliados os parâmetros de rigidez, força máxima, deformidade máxima e energia. RESULTADOS: Não houve diferença estatisticamente significante em relação à força no limite de proporcionalidade, rigidez e força máxima entre os grupos com sutura simples e com âncora. CONCLUSÃO: Por meio dos ensaios biomecânicos, tendo como parâmetro a rigidez, a força máxima, a deformidade máxima e a energia, ficou demonstrado que as capsulorrafias em quadris de coelhos com sutura simples e com âncora são semelhantes entre si. Nível de Evidência II, Estudo Prospectivo Comparativo.OBJECTIVE: Using biomechanical studies, this research aims to compare hip capsulorrhaphy in rabbits, carried out with two different techniques: capsulorrhaphy with simple sutures and with anchors. METHOD: Thirteen New Zealand Albino (Oryctolaguscuniculus) male rabbits, twenty-six hip joints, were used. First, a pilot project was performed with three rabbits (six hip joints). This experiment consisted of ten rabbits divided into two groups: group 1 underwent capsulorrhaphy on both right and left hips with simple suture using polyglycolic acid absorbable thread, and group 2 underwent capsulorrhaphy with titanium anchors. After a four-week postoperative period, the animals were euthanized and the hip joints were frozen. On the same day of the biomechanical studies, after the hip joints were previously unfrozen, the following parameters were evaluated: rigidity, maximum force, maximum deformity and energy. RESULTS: There was no relevant statistical difference in rigidity, maximum force, maximum deformity and energy between the simple suture and anchor groups. CONCLUSION: Through biomechanical analyses, using parameters of rigidity, maximum force, maximum deformity and energy, it has been shown that capsulorrhaphy with simple suture and with anchors has similar results in rabbit hip joints. Level of Evidence II, Prospective Comparative Study.

OBJETIVO: Estimar a prevalência da síndrome da apneia obstrutiva do sono (SAOS) em crianças e adolescentes com anemia falciforme (AF) e investigar a possível correlação entre hemoglobina anual média e tempo total de sono com SpO2 < 90% e tempo total de sono com SpO2 < 80%, assim como investigar a possível correlação entre o índice de apneia-hipopneia (IAH) e episódios de crise álgica. MÉTODOS: Participaram 85 pacientes com AF, que responderam a um questionário, foram avaliados por um pediatra e um otorrinolaringologista, e submetidos a estudo polissonográfico. O diagnóstico de SAOS foi definido como IAH > 1. RESULTADOS: A prevalência da SAOS foi 10,6%. Observou-se uma correlação negativa entre hemoglobina anual média e tempo total de sono com SpO2 < 90% (r = µ0,343; p = 0,002) e tempo total de sono com SpO2 < 80% (r = µ0,270; p = 0,016). Não foi observada associação entre IAH e episódios de crise álgica. CONCLUSÕES: A prevalência da SAOS nesta população foi alta (10,6%). Portanto, é importante identificar precocemente os sinais de SAOS e avaliar hemoglobina anual média, devido à correlação inversa entre essa e o tempo total de sono com SpO2 < 90% ou < 80%.OBJECTIVE: To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90%, as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80%; and to investigate the possible correlation between apnea-hypopnea index (AHI) and painful crisis. METHODS: The study involved 85 patients with SCA. The patients completed a questionnaire, were submitted to polysomnography and underwent clinical evaluation (by a pediatrician and an otolaryngologist). An AHI > 1 was considered indicative of a diagnosis of OSAS. RESULTS: The prevalence of OSAS was 10.6%. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90% (r = µ0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80% (r = µ0.270; p = 0.016). There was no association between AHI and painful crisis. CONCLUSIONS: The prevalence of OSAS in this population was high (10.6%). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO2 < 90% or < 80%.

OBJETIVO: Estimar a prevalência de dor crônica, identificando os fatores associados. MÉTODOS: Estudo transversal realizado em amostra populacional de 2.297 indivíduos com idade igual ou superior a 20 anos, em Salvador (BA), em 1999 e 2000. Aplicou-se em domicílio questionário padronizado para coleta de dados sobre dor e características sociodemográficas e a medida da circunferência abdominal. O critério para classificação de dor crônica foi duração superior a seis meses. Foram estimadas as prevalências de dor por razão de prevalência ajustada com intervalo com 95% de confiança e valor de pOBJETIVO: Estimar la prevalencia de dolor crónico, identificando los factores asociados. MÉTODOS: Estudio transversal realizado en muestra poblacional de 2.297 individuos con edad igual o superior a 20 años, en Salvador (Noreste de Brasil), en 1999 y 2000. Se aplicó en domicilio cuestionario estandarizado para colectar datos sobre dolor y características sociodemográficas y la medida de la circunferencia abdominal. El criterio para clasificación de dolor crónico fue duración superior a seis meses. Fueron estimadas las prevalencias de dolor por razón de prevalencia ajustada con intervalo con 95% de confianza y valor de pOBJECTIVE: To estimate the prevalence of chronic pain, identifying the associated factors. METHODS: A cross-sectional study was conducted in a population sample of 2,297 individuals aged 20 years or more, in Salvador, Northeastern Brazil, in 1999 and 2000. A standardized questionnaire was administered at the individuals' home to collect data about pain, sociodemographic characteristics, and abdominal circumference measurement. The criterion for chronic pain classification was duration above six months. Prevalence of pain was estimated by adjusted prevalence ratio with confidence interval of 95% and p

OBJETIVOS: Determinar a prevalência da hipertrofia adenotonsilar obstrutiva em crianças e adolescentes portadores de anemia falciforme; investigar possível associação entre presença de mais de cinco episódios de tonsilite nos últimos 12 meses e episódios de crise álgica no mesmo período; e comparar a hemoglobina anual média entre os que apresentam e os que não apresentam hipertrofia adenotonsilar obstrutiva. MÉTODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 crianças e adolescentes com anemia falciforme. Todos responderam questionário e avaliação otorrinolaringológica, incluindo endoscopia nasossinusal. Para o diagnóstico da hipertrofia adenotonsilar obstrutiva foram adotados os critérios de Brodsky. RESULTADOS: A prevalência da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se à história de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presença de mais de cinco episódios de tonsilites nos últimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior número de infecções das vias aéreas superiores (62,5 versus 37,5; p = 0,010). Também foi observada associação entre presença de mais de cinco episódios de tonsilite nos últimos 12 meses e episódios de crise álgica no mesmo período (mediana = 12 versus 2; p = 0,017). Não houve diferença significante da hemoglobina anual média entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar não-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSÃO: A prevalência da hipertrofia adenotonsilar obstrutiva foi de 55,3% em crianças e adolescentes com anemia falciforme. A presença de mais de cinco episódios de tonsilite nos últimos 12 meses associaram-se com episódios de crise álgica no mesmo período; e não houve diferença quanto ao valor da hemoglobina anual média entre os que apresentaram e os que não apresentaram hipertrofia adenotonsilar obstrutiva.OBJECTIVES: To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. METHODS: Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. RESULTS: The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. CONCLUSION: The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy.

INTRODUÇÃO: A dor lombar crônica atinge níveis epidêmicos na população geral e informações sobre o perfil das pessoas atingidas podem ajudar a direcionar investimentos para seu controle. OBJETIVO: Estimar a prevalência de dor lombar crônica na população e identificar fatores associados. MÉTODOS: Estudo transversal com base em inquérito populacional, desenvolvido em setores censitários da cidade de Salvador classificados por nível socioeconômico. Foram entrevistados 2.297 indivíduos em que se avaliou a presença de dor lombar através do mapa corporal. A análise exploratória dos fatores associados foi realizada pela regressão logística. RESULTADOS: A prevalência de dor lombar crônica na população foi de 14,7%, com maior freqüência entre ex-fumantes (19,7%), pessoas com circunferência da cintura acima da normalidade (16,8%) e com escolaridade baixa (17,4%) em relação com as demais categorias. Fatores como atividade física, classe social, consumo excessivo de álcool, raça, sexo e ocupação na época da entrevista não estiveram associados à dor lombar. Na análise de regressão múltipla, estado civil solteiro associou-se negativamente com dor lombar crônica, enquanto associações positivas e estatisticamente significantes foram observadas entre o tabagismo atual ou no passado e a dor lombar (OR 1,47; IC95%; 1,11-1,96; p < 0,000). CONCLUSÃO: A população de Salvador apresenta alta prevalência de dor lombar crônica associada ao tabagismo.INTRODUCTION: Chronic low back pain has epidemic levels in the general population and profiling the individuals affected may help directing investments to control the problem. OBJECTIVE: To estimate the prevalence of chronic low back pain in the population and to identify associated factors. METHODS: Transversal study based on a population survey carried out in the sectors classified by the census in the city of Salvador according to socio-economic level. 2,297 individuals were interviewed in whom low back pain was evaluated through a bodily map. Exploratory analysis of associated factors was performed by logistic regression. RESULTS: Chronic low back pain prevalence in the population was 14.7%, with higher incidence among former smokers (19.7%), people with belly circumference above the range of normality (16.8%), and individuals with low level of schooling (17.4%) when compared to the other categories. Factors such as physical activity, social class, excessive alcohol intake, race, gender, and occupation at the time of the interview were not associated to low back pain. In the multiple regression analysis, being single was negatively associated to chronic low back pain, whereas positive and statistically significant associations were observed between current smoking or smoking in the past and low back pain (OR 1.47; IC95%; 1.11-1.96; p < 0.000). CONCLUSION: The population in Salvador shows high prevalence of chronic low back pain associated to smoking.

PURPOSE: To check the effect of zoledronate in bone remodeling during bone healing. METHODS: Thirty rabbits were divided into two groups of fifteen animals each (control and experimental group respectively). Shaft osteotomy was performed on the cranial portion of the fibula of each animal. In the experimental group, a single dose of 0.04mg/kg of zoledronate was administered. In the control group, the same volume of bi-distilled water was administered. After one, two and four weeks, animals of both groups were killed and histological sections of the fibular metaphyseal area were examined histomorphometrically. The parameters analyzed were tissue volume (TV), fractional trabecular bone volume (BV/TV) and fractional medullary fibrous volume (FbV/TV). RESULTS: Tissue volume increased in the experimental group (237.2mm².10-2) compared to the control (166.62mm².10-2). Trabecular bone volume was significantly larger in the experimental (60.2%) than in the control group (34.8%).The amount of fibrosis volume decreased in the experimental group (22%) compared to the control (49.4%). CONCLUSION: The effect of zoledronate is characterized by accentuated stimulus of bone formation in the metaphyseal area, resulting in a larger amount of trabecular bone volume and little fibrosis volume.OBJETIVO: Verificar os efeitos do zoledronato na remodelação óssea durante a reparação óssea. MÉTODOS: Trinta coelhos foram divididos em dois grupos de quinze animais cada (grupos controle e experimento, respectivamente). Realizou-se osteotomia na diáfise proximal da fíbula de cada animal. No grupo experimento, aplicou-se dose única de 0,04mg/Kg de zoledronato. No grupo controle, a mesma quantidade de água bi-destilada foi administrada. Após uma, duas e quatro semanas, os animais de ambos os grupos foram sacrificados e cortes histológicos da metáfise fibular foram examinados histomorfometricamente. Os parâmetros analisados foram volume tecidual (TV), fração do volume ósseo trabecular (BV/TV) e fração do volume fibroso medular (FbV/TV). RESULTADOS: O volume tecidual aumentou no grupo experimento (237.2mm².10-2) em comparação com o controle (166.62mm².10-2). O volume ósseo Trabecular teve aumento significativo no grupo experimento (60.2%) em relação ao grupo controle (34.8%). A quantidade de fibrose medular diminuiu no grupo experimento (22%) em comparação com o controle (49.4%). CONCLUSÃO: O efeito do zoledronato é caracterizado por acentuado estímulo da formação óssea na área metafisária, resultando em grande quantidade de volume ósseo trabecular e pouca fibrose medular.

Monochromatic documents claim for much less computer bandwidth for network transmission and storage space than their color or even grayscale equivalent. The binarization of historical documents is far more complex than recent ones as paper aging, color, texture, translucidity, stains, back-to-front interference, kind and color of ink used in handwriting, printing process, digitalization process, etc. are some of the factors that affect binarization. This article presents a new binarization algorithm for historical documents. The new global filter proposed is performed in four steps: filtering the image using a bilateral filter, splitting image into the RGB components, decision-making for each RGB channel based on an adaptive binarization method inspired by Otsu’s method with a choice of the threshold level, and classification of the binarized images to decide which of the RGB components best preserved the document information in the foreground. The quantitative and qualitative assessment made with 23 binarization algorithms in three sets of “real world” documents showed very good results.

From 1995 to 1998, twenty seven pediatric patients were included in a prospective clinical study. Their age ranging from 8.9 to 17.5 years old (mean 13.5), 20 (74%) were male and 7(26%) female, with a follow-up going from 3 to 39 months (average of 17). Osteogenic sarcoma arises in Knee (55.5%), ankle (26%), shoulder (11.1%), pelvis (3.7%) and hip (3.7%). Tumors less than 12cm were considered being small ones, while those bigger than 12cm were considered large. .All patients were submitted to clinical, radiological, histological evaluation and graded by Enneking(5) system (13 were IIB and 8 were IIIB); treated by chemotherapeutic agents, according to "Brazillian Protocol 91" and had a local surgical control. There were carried out 9 (42.9%) radical surgical interventions and 12 (57.1%) surgeries of limb preservation. According to lesion size, eight (38.1%) out of 14 (67.9%) patients with a tumor greater than 12cm died; in contrast, none out of 7 with tumor less than 12cm relapsed or died. Authors have concluded that tumor size can be a good factor for prognosis indication, being low cost, simple, easy to reproduce and specially useful for taking pre-treatmente decisions.

An outbreak of compressive myelopathy in cattle associated with the improper use of an oil vaccine is described. Neurological signs were observed in 25 out of 3,000 cattle after 60 days of being vaccinated against foot and mouth disease. The clinical picture was characterized by progressive paralysis of the hind limbs, difficulty in standing up, and sternal recumbency during the course of 2-5 months. A filling defect between the L1 and L3 vertebrae was seen through myelography performed in one of the affected animals. A yellow-gray, granular and irregular mass was observed in four necropsied animals involving the spinal nerve roots and epidural space of the lumbar (L1-L4) spinal cord; the mass was associated with a whitish oily fluid. This fluid was also found in association with necrosis of the longissimus dorsi muscle. Microscopic changes in the epidural space, nerve roots, and spinal musculature were similar and consisted of granulomas or pyogranulomas around circular unstained spaces (vacuoles). These spaces were located between areas of severe diffuse hyaline necrosis of muscle fibers and resembled the drops of oil present in the vaccine.

Apresenta-se um modelo experimental de osteotomia de fíbula em coelhos com esqueleto imaturo adequado para o estudo do processo de reparação óssea. A osteotomia foi realizada por serra elétrica padronizada, sem utilização de dispositivos de fixação. Este modelo foi testado em cinco coelhos e constou da descrição detalhada de técnica operatória, anestesia e técnica radiográfica. Os animais foram submetidos a eutanásia após cinco semanas e tiveram suas fíbulas encaminhadas para avaliação histológica. Comprovou-se que o modelo é eficiente, simples e de fácil execução, tornando-se opção atraente para todos aqueles que desejam realizar estudos de consolidação óssea durante a imaturidade esquelética.Authors present an experimental model for fibular osteotomy in immature rabbits usefull to study healing bone process. Osteotomy was produced by means of eletric saw without utilization of fixing devices. This model was applied in five rabbit were sacrified after five weeks and had their fibular send for histological evaluation. Operative technique, anesthesia, roetigenografic technique were detailed discribed. The model was proved to be efficient, simple and of easy execution, becoming an atractive option for whoever wish to perform studies of bone healing through skeleon development.

INTRODUÇÃO: Pacientes infectados pelo HIV apresentam osteoporose ou osteopenia densitométrica numa taxa de 28 a 50%. O objetivo deste estudo é verificar alterações na taxa de reabsorção/formação destes pacientes. MATERIAL E MÉTODOS: Realizou-se revisão sistemática com metanálise de estudos controlados que avaliaram a associação entre osteopenia e/ou alterações no metabolismo ósseo com a infecção pelo HIV. Todos os estudos que incluíam osteocalcina ou NTX com marcadores respectivos de formação e reabsorção ósseos foram incuidos. Cinco estudos foram classificados como evidência classe III e envolveram 456 indivíduos HIV positivos e 590 controles. O NTX teve aumento significante (p < 0.00014) no grupo HIV-positivo, enquanto osteocalcina não se mostrou alterada. CONCLUSÃO: O presente estudo permite concluir que, durante a infecção pelo HIV, o marcador NTX está significantemente elevado, refletido alta atividade reabsortiva no tecido ósseo. Isto aponta um papel importante na atividade osteoclástica na perda óssea de pacientes HIV-positivos.INTRODUCTION: HIV-infected patients show osteoporosis or densitometric osteopenia at a rate of 28-50%. The objective of this study is to check the changes on reabsorption/ development rates on these patients. MATERIALS AND METHODS: A systematic review was carried out with meta-analysis of controlled studies assessing the correlation between osteopenia and/ or bone metabolism changes with HIV infection. All studies including osteocalcin or NTX with corresponding markers of bone development and reabsorption were included. Five studies were classified as class-III evidence, and involved 456 HIV-positive individuals and 590 controls. NTX had a significant increase (p < 0.00014) on the HIV-positive group, while osteocalcin has shown to be unchanged. CONCLUSION: This study allows us to conclude that, during HIV infection, the NTX marker is significantly high, reflecting a high reabsorptive activity on the bone tissue. This suggests an important role on osteoclastic activity in bone loss for HIV-positive patients.

Classificar corretamente as fraturas acetabulares é crucial para bom planejamento pré-operatório e para redução cirúrgica eficiente. Entretanto, para cumprir seus objetivos, qualquer sistema de classificação deve ser simples e reprodutível. O objetivo deste artigo é avaliar a reprodutibilidade interobservador da classificação de Tile para fraturas do acetábulo. Foram utilizadas 30 imagens radiográficas de 10 fraturas acetabulares nas incidências de Judet, analisadas por 10 observadores, sendo cinco especialistas em cirurgia de quadril e cinco residentes do terceiro ano de ortopedia. A concordância global obtida foi de 72,44% com Kappa (K) = 0,52 (0,48 entre residentes e 0,57 entre especialistas). Conclui-se que a classificação de Tile para fraturas acetabulares apresenta moderada concordância interobservador, não havendo diferença estatisticamente significante entre residentes e especialistas.Properly classifying acetabular fractures is crucial for a good preoperative planning and for an efficient surgical reduction. However, in order to accomplish its objectives, any classification system must be simple and reproducible. The objective of this article is to assess inter-observer reproducibility of Tile’s classification concerning acetabular fractures. Thirty X-ray images of 10 acetabular fractures at Judet planes were used and assessed by 10 observers, being five hip surgery experts and five 3rd-grade orthopaedic residents. The global consistency achieved was 72.44% to Kappa (K) = 0.52 (0.48 among resident doctors and 0.57 among experts). It was concluded that the Tile’s classification of acetabular fractures reveals a moderate inter-observer consistency, with no statistically significant difference between resident doctors and experts.

A instabilidade atlantoaxial (IAA) é caracterizada pelo aumento da mobilidade da articulação C1-C2 devido a frouxidão ligamentar alar, sendo freqüente em portadores da Síndrome de Down. O objetivo deste trabalho é estudar a freqüência de IAA e sua associação com hiperfrouxidão ligamentar generalizada em pacientes com Síndrome de Down. Selecionou-se 80 crianças, 34 (42,5%) masculinos e 46 (57,5%) femininos, com idades entre 5,6 e 15 anos (média de 9). Os pacientes foram avaliados por questionário e radiografia em perfil da coluna cervical em flexão. Encontrou-se sintomatologia clínica em 58%, comumente relatada como fraqueza em membros inferiores. A distância atlanto-odontoidal foi de até 4,5 mm em 77,5% , de 4,5 a 6 mm em 15% e, maior que 6 mm em 7,5% dos pacientes avaliados. Os pacientes portadores de hiperfrouxidão ligamentar generalizada (grupo 1) não apresentaram maior freqüência de IAA em relação aos não portadores de hiperfrouxidão (grupo 2). Os autores concluíram que a IAA apresenta alta freqüência na síndrome de Down, não havendo associação direta com hiperfrouxidão ligamentar generalizada.Atlantoaxial instability (AAI) is characterized by hypermobility of C1-C2 joint due to laxity of alar ligament, being common in Down syndrome patients. The aim of this study is to verify AAI incidence and its association with generalized ligamentous laxity in Down syndrome. Eighty children were selected, 34 (42.5%) males and 46 (57.5%) females, aged from 5.6 to 15 years-old (average = 9). Patients were evaluated by questionaire and an X-ray imaging of cervical spine in a flexed lateral view. Clinical features amount to 58%, most expressed as weakness of lower limbs. 77,5% of atlanto-odontoid spaces were as small as 4.5mm; 15% were between 4.5 to 6mm; and 7.5% were greater than 6mm. Patients presenting generalized ligamentous laxity (group 1) did not show a greater incidence of AAI compared to those not presenting that condition (group 2). The authors concluded that AAI is a common disorder in Down syndrome, having no direct association to generalized ligamentous laxity.

Introduction Mucopolysaccharidosis (MPS) are a group of rare orthopedic disorders caused by heterogeneous genetic abnormalities in which lysosomal storage alteration lead to intracellular accumulation of glycosaminoglycans (GAGs) that injure and create dysfunction of varying degrees in multiple organs and systems, in a progressive and lethal way. The type of MPS can be classified according to the enzyme defect by which it is determined or according to its clinical manifestations and the progression of the disease The impairment of the musculoskeletal system or “dysostosis multiplex” is a common feature in all MPSs. It is characterized by osteoarticular deformities (kyphosis, scoliosis, knee valgus, equinovarus), joint stiffness with a loss in range of motion (ROM), and upper motor neuron impairment (myelopathy, hypertonia, spasticity). There is no specific motor function classification system for individuals with MPS. However, the progression of motor function impairment such as walking, sitting, and functional independence in day to day activities is directly related to the severity of the disorder...

Background. The objective of the treatment of open fracture is to prevent infection, stabilize the bones, and restore function. However, infection is the most important step in achieving the latter aims. Objective. The objective of the current paper is to find risk factors associated with infection in a sample of tibial open fractures. Patients and Methods. A retrospective analysis was carried out. The study included all patients who underwent to tibial open fracture treatment in the Hospital Geral Roberto Santos-HGRS, Salvador, Bahia, Brasil, from March to October, 2009. Patients under the age of eight, with multiple fractures or suffering from systemic or bone disease were excluded. Clinical and demographic data were collected and Patient outcomes were divided into two groups: Group 1 comprises those without infection whereas group 2 comprises those with lesions which became infected. The two groups were evaluated in search for associated factors that could lead to infection. Results. We studied 50 patients. Our overall infection rate was 14 (28%; CI95%=15.5-40.5). Infection was significantly associated with place of trauma (OR 3.78; CI95%=1.4-5.5; p=0.02), and time delay superior to 24 hours (OR 3.4; CI95%=1.4-20.8; p=0.03). Fractures graded as Gustilo I, II and IIIA had a lower chance for infection compared to Gustilo IIIB and IIIC (OR 4.32; CI95%=1.3-19.1; p=0.01). Fractures graded Tscherne III and IV had a higher chance for infection, and it was the most significant isolated factor (OR 8.07; CI95%=2.4-47.1; p

Recentemente a Casa de Lucio Costa disponibilizou os originais das versões não construídas de Lucio Costa e Oscar Niemeyer para o Pavilhão do Brasil, na Feira de 1939, em Nova Iorque. Os preciosos e, até então, não divulgados registros foram digitalizados no Laboratório de História e Teoria da Arquitetura da UniRitter, em Porto Alegre, Rio Grande do Sul, Brasil, Instituição sede da pesquisa intitulada “Lucio Costa: Obra Completa”, a pedido da arquiteta Maria Elisa Costa, dirigente da Casa de Lucio Costa - responsável por grande parte do acervo do arquiteto. Analisamos, neste trabalho, a versão de Oscar Niemeyer do Pavilhão a partir dos documentos que tivemos oportunidade de manusear e que apresentamos aqui e, principalmente, a versão de Lucio Costa, cuja análise foi complementada pelo redesenho com utilização de tecnologias atuais e modelagem em computação gráfica.