Repositório Institucional - Unifesp :: Navegando por Palavras-chave "complications"

Navegando por Palavras-chave "complications"

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Cirurgia endoscópica transnasal da região selar: estudo dos primeiros 100 casos
(Academia Brasileira de Neurologia - ABNEURO, 2003-09-01) Gondim, Jackson [UNIFESP]; Schops, Michele [UNIFESP]; Tella Jr, Oswaldo I. [UNIFESP]; Hospital Geral de Fortaleza; Universidade Federal de São Paulo (UNIFESP)
An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas); 21 null cell adenomas (3 microadenomas and 18 macroadenomas); 19 Cushing disease (11 microadenomas and 8 macroadenomas), 10 prolactinomas (6 microadenomas and 4 macroadenomas), and 4 LH adenomas (4 macroadenomas). In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function, and reduction of hospitalization times and coasts. The main limits have been the reduction of field depth, constant need of manual control of the endoscope, and required experience of the endoscope technique.
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Diagnosis of epithelial ingrowth after penetrating keratoplasty with confocal microscopy
(Lippincott Williams & Wilkins, 2006-10-01) Forseto, Adriana dos Santos; Santos, Myrna Serapiao dos; Sampaio, Angelica; Mascaro, Vera; Nose, Walton; Eye Clin Day Hosp; Universidade Federal de São Paulo (UNIFESP); Hosp Servidor Publ Estadual
Purpose: To report confocal microscopy use in the clinical diagnosis of epithelial ingrowth after penetrating keratoplasty (PKP).Methods: A 36-year-old female patient with keratoconus developed a well-delimited posterior hazy membrane covering the inferior two thirds of the cornea 3 months after an uneventful PKP. A posterior corneal line was present resembling an endothelial graft rejection line, but with no keratic precipitates or corneal edema. Ocular hypertension was not observed, Confocal microscopy was performed to elucidate the diagnosis.Results: Confocal microscopy showed epithelium and stroma with normal findings. Two distinct cellular types were presented at the endothelium layer. Enlarged endothelial cells were observed in the superior part of the cornea up to the leading edge of the hazy membrane. in the middle and inferior part of the graft, the cells were larger, with polygonal shape and easily recognizable hyperreflective nuclei, suggestive of epithelial cells. With these confocal microscopy findings, the patient was promptly submitted to another PKP. Histologic analysis confirmed the diagnosis of epithelial ingrowth.Conclusion: Confocal microscopy imaging technique seems to be a useful tool in the early diagnosis of epithelial ingrowth after PKP.
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Imaging Evaluation of Developmental Hip Dysplasia in the Young Adult
(Amer Roentgen Ray Soc, 2013-05-01) Beltran, Luis S.; Rosenberg, Zehava S.; Mayo, Jason D.; Diaz de Tuesta, Maria; Martin, Olga; Pecci Neto, Luis [UNIFESP]; Bencardino, Jenny T.; New York Univ; Hosp Joint Dis & Med Ctr; New Britain Radiol Associates; Hosp Univ Ramon y Cajal; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE. the purpose of this article is to review the clinical and imaging features as well as the potential complications of hip dysplasia in the young adult. Hip dysplasia is an important cause of secondary osteoarthrosis, which accounts for a significant proportion of patients requiring total hip arthroplasty. the radiographic diagnosis of mild hip dysplasia in the young adult may be subtle and is primarily based on the detection of deficient coverage of the femoral head by the acetabulum.CONCLUSION. Cross-sectional imaging, including CT and MRI, afford improved detection and characterization by providing morphologic information about acetabular deficiency. MRI also allows evaluation of potential associated injuries to the articular cartilage, the labrum, and the ligamentum teres. Familiarity with the radiographic and cross-sectional imaging findings of mild hip dysplasia in the young adult may allow a timely diagnosis and implementation of treatment strategies, which may prevent or delay the development of early osteoarthritis.
Acesso aberto (Open Access)
Incidence and Risk Factors for Cardiovascular Collapse After Unplanned Extubations in the Pediatric ICU
(Daedalus Enterprises Inc, 2017) Lucas da Silva, Paulo Sergio; Machado Fonseca, Marcelo Cunio [UNIFESP]
BACKGROUND: Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients. METHODS: All children who had been mechanically ventilated for >= 12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were between ages 1 month and 16 y and had experienced UE. They were analyzed in 2 groups: those with cardiovascular collapse (defined as the need for cardiopulmonary resuscitation or circulatory dysfunction immediately after UE) and those with no cardiovascular collapse. RESULTS: Of the 847 subjects, 109 UEs occurred in 14,293 intubation days (0.76 UEs/100 intubation days), with 21 subjects (19.2%) experiencing cardiovascular collapse, of which 10 required cardiopulmonary resuscitation. Compared with subjects without cardiovascular collapse after UE, children with cardiovascular collapse were younger(<6 months old), with respiratory failure from lower respiratory tract diseases, lower P-aO2/F-IO2 (218 vs 282 mm Hg), and higher oxygenation indices (5.5 vs 3.5) before UE events. Logistic regression revealed that only an age <6 months old was strongly associated with cardiovascular collapse (odds ratio 3.4, P = .03). There were no differences between cardiovascular collapse and non-cardiovascular collapse subjects regarding the length of hospital stay, ventilator-associated pneumonia rate, and mortality. CONCLUSIONS: Cardiovascular collapse is a frequent complication of UEs, particularly in the youngest children. Specific bundles to prevent UEs may reduce morbidity related to these events.
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Intubação difícil e sua correlação com preditores clínicos
(Universidade Federal de São Paulo (UNIFESP), 2016-10-26) Lanzoni, Rodrigo Medeiros [UNIFESP]; Amaral, Jose Luiz Gomes Do Amaral [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background: Difficult tracheal intubation (DTI) and failed airway control are responsible for 2.3% of deaths related to anesthesia in the United States. The incidence of DTI is about 5.8% in patients with no airway pathological features. It is essential to identify difficult intubation in order to reduce the incidence of morbimortality. This study aims to evaluate the incidence of DTI in a Brazilian university hospital and identify factors associated with this condition. Methods: This is a retrospective descriptive study that analyzed the pre-anesthetic evaluations and anesthesia reports in a university hospital complex in the city of São Paulo in the 3- year period. We included patients aged over 18 years who underwent endotracheal intubation. For continuous variables we applied the Kolmogorov-Smirnov normality test. The variables with non-normal distribution were expressed as median (p25- p75) and performed the non-parametric Mann-Whitney. The categorical variables were represented by absolute value and percentage, and compared through Chisquare test of Pearson. It was considered statistically significant at p <0.05. Results: From a total of 5,469 anesthesia performed, 1,875 cases were included. The incidence of DTI was 5.07% (95 cases). After multivariate analysis, only Mallampati classification and thyromental distance were associated with DTI. In addition, we defined a logistic model with high sensitivity (81.6%) but low specificity (57.7%) in predicting DTI. Conclusion: The incidence of DTI in the study population was 5.07% and the factors associated with it were Mallampati grades III and IV and thyromental distance <6 cm.
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Ocular wavefront aberrations in patients after diffuse lamellar keratitis
(Lippincott Williams & Wilkins, 2007-01-01) Beer, Sandra Maria Canelas; Campos, Mauro; Lopes, Paraguassu Tibirica; Andre, Jose Armando; Schor, Paulo; Universidade Federal de São Paulo (UNIFESP)
Purpose: To study ocular wavefront aberrations after laser in situ keratomileusis (LASIK) in patients who developed diffuse lamellar keratitis (DLK).Methods: A case-control evaluation of 47 patients with DLK and 30 uneventful LASIK-operated controls. Measurements of visual acuities, cycloplegic refraction, eye's wave aberrations using a LADARWAVE aberrometer (up to eighth order), and corneal topography were obtained after LASIK treatment. All of the surgeries were performed using the Hansatome or the Moria microkeratome and the LadarVision excimer laser system.Results: Mean follow-up interval from the day of the operative procedure to the examination day was 6.26 (DLK group; range, 2-13 months) and 6.23 months (control group; range, 3-9 months). Mean preoperative spherical equivalent was -3.7 D in patients with DLK and -3.7 D in controls. High-order aberration S7+7 (P = 0.015) was statistically different in the DLK group from that in controls. High-order aberrations S3+3 (P = 0.091) and S8+4 (chi(2) = 8.014, P = 0.046) showed a tendency to be different from controls. Loss of best-corrected visual acuity was greater in patients with DLK.Conclusions: the occurrence of DLK after LASIK surgery may not significantly affect the visual outcome.
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Options in pediatric glaucoma after angle surgery has failed
(Lippincott Williams & Wilkins, 2006-04-01) Tanimoto, S. A.; Brandt, J. D.; Univ Calif Davis; Universidade Federal de São Paulo (UNIFESP)
Purpose of reviewCongenital glaucoma is primarily a surgical disease with medical management serving as a temporizing measure before surgery or as postoperative adjunctive treatment. First-line surgery for congenital glaucoma consists of incisional procedures on the anterior chamber angle: goniotomy and trabeculotomy. Angle surgery has a high success rate with few complications. Despite the high initial success rate, almost 20% of angle procedures eventually fail, and surgeons are confronted with a choice of what procedure to do next: a trabeculectomy with or without adjunctive antifibrosis therapy, glaucoma drainage surgery, or cyclodestructive procedures. This review will discuss and compare these procedures as reported in recent studies-and how variables such as age, number of prior procedures, and type of glaucoma have clarified the order in which these procedures might be performed after failed angle surgery.Recent findingsClinical reports in refractory pediatric glaucoma consist solely of retrospective studies of varying size and quality. Recent studies of trabeculectomy in this population suggest mitomycin C is associated with increased risk of late infectious,complications. Trabeculectomy has worse outcome among younger patients Glaucoma drainage devices have a success rate approaching 80% at 1 year, but less with longer follow-up. Cyclodestructive procedures are generally reserved for advanced cases, but low-dose cyclodiode therapy and endocyclophotocoagulation may prove useful earlier in the disease (< 2 years).SummaryRefractory pediatric glaucoma remains a challenge. Glaucoma drainage devices appear to be the most predictable and possibly safest procedure to consider after failed conventional angle surgery.
Acesso aberto (Open Access)
Paciente com acidente vascular cerebral isquêmico já é atendido com mais rapidez no Hospital São Paulo
(Academia Brasileira de Neurologia - ABNEURO, 2004-03-01) Yamashita, Lilia Fumie [UNIFESP]; Fukujima, Marcia Maiumi [UNIFESP]; Granitoff, Nina [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
We observed inpatients with the diagnosis of ischemic stroke hospitalized at least 24 hours. We investigated the reasons for early or late arrival to the Emergency Room, the time span from arrival to computed tomography (CT) scanning, factors associated to hospitalization time, and patients outcome. We concluded that people who are cared for by São Paulo Hospital now get to the hospital sooner than they did 3 years ago (47% arrived in 3 hours or less) and that the patient flow inside the hospital became much faster, once any stroke patient is considered now a medical emergency by the hospital staff. Infections were the main complications presented by our patients, which is leading us to optimize protocols to improve emergency care by all the staff.
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Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study
(Elsevier B.V., 2007-11-01) Carvalho Schettini, Juliana A. de; Ramos de Amorim, Melania Maria; Ribeiro Costa, Aurelio Antonio; Albuquerque Neto, Luiz Cavalcante; Inst Materno Infantil Pernambuco; Universidade Federal de São Paulo (UNIFESP)
STUDY OBJECTIVE: To evaluate and determine the main causes for pain occurrence and intensity in outpatients undergoing anesthesia-free hysteroscopy in a medical school hospital.DESIGN: Cohort study (Canadian Task Force classification II-2).SETTING: Diagnosis Center of the Instituto Materno-Infantil de Pernambuco.PATIENTS: One hundred seventy-one outpatients undergoing anesthesia-free diagnostic hysteroscopy.INTERVENTION: To assess pain occurrence, intensity, and associated factors reported by patients undergoing anesthesia-free diagnostic hysteroscopy.MEASUREMENTS and MAIN RESULTS: Pain frequency and intensity were determined by visual analog scale (VAS) at the end of the procedure and at 15-, 30-, and 60-minute intervals. Data analysis of clinical, obstetric, and gynecologic history and its association with pain was performed. Association through X-2 test (Pearson), risk ratio with 95% Cl, and multiple logistic regression were used for statistical analysis. Pain score was higher immediately after the procedure with a median of 6, decreasing to 3, 1, and 0 at 15-, 30-, and 60-minute intervals, respectively. Multiple logistic regression was performed, and the only parameters remaining that were significantly associated with pain were menopause, speculum placement, and the absence of previous vaginal delivery.CONCLUSION: Anesthesia-free diagnostic hysteroscopy is often associated with pain, and it has been determined that menopause, speculum placement, and absence of previous vaginal delivery are factors associated with pain occurrence and intensity. (C) 2007 AAGL. All rights reserved.
Acesso aberto (Open Access)
Prevalência das lesões associadas na luxação recidivante traumática do ombro
(Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Carrazzone, Oreste Lemos [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Ambra, Luiz Felipe Morlin [UNIFESP]; Neto, Nicola Archetti [UNIFESP]; Matsumoto, Marcelo Hide [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate the prevalence of lesions associated with traumatic anterior shoulder instability and the relationships between the prevalence of these lesions and the number of episodes and time since symptoms started. METHOD: Fifty-seven patients aged 18 to 40 years, with traumatic anterior shoulder instability, more than one episode of shoulder dislocation and at least six months since the first dislocation, who required surgery to treat the instability, were selected. Arthroscopic inspection was performed on all the patients to assess any associated lesions. RESULTS: The prevalence of lesions was assessed, and Bankert lesions were the most prevalent, followed by Hill-Sachs lesions, while rotator cuff injuries were the least prevalent. There was no correlation from comparison between the number of episodes of dislocation and the prevalence of associated lesions. On the other hand, in relation to the time since symptoms started, the patients who had had symptoms for longer times had fewer Hill-Sachs lesions. CONCLUSION: It was not possible to affirm that, in patients with chronic shoulder instability, the numbers of associated lesions increased with the time since symptoms started, or with the number of episodes of dislocation.
Acesso aberto (Open Access)
Recurrent vesicourethal stenosis after radical prostatectomy: how to treat it?
(Sociedade Brasileira de Urologia, 2005-12-01) Barreto, Françualdo [UNIFESP]; Dall'oglio, Marcos [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Vesicourethral anastomotic stricture and urinary incontinence are severe complications of radical prostatectomy because they cause great impact in the quality of life. Three patients that presented these complications after prostate radical surgery were assessed retrospectively. To treat the stenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincter AMS 800 was implanted to treat the resulting urinary incontinence.
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Risk Factors and Outcomes of Unplanned PICU Postoperative Admissions: A Nested Case-Control Study
(Lippincott Williams & Wilkins, 2013-05-01) Lucas da Silva, Paulo Sergio [UNIFESP]; Aguiar, Vania Euzebio de [UNIFESP]; Machado Fonseca, Marcelo Cunio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background: Although unplanned postoperative admission to PICUs (unplanned intensive care admission [UIA]) is uncommon, it might be associated with increased costs, morbidity, and mortality. However, detailed knowledge of risk factors and outcomes after UIA in children is still lacking.Objectives: To determine prevalence, risk factors, and outcomes of UIA patients compared with non-UIA patients.Design: Case-control study.Setting: A tertiary university-affiliated hospital.Patients: All postoperative children admitted to the PICU were monitored for UIA. About 28 cases and 88 controls were included.Interventions: none.Measurements and Main Results: the overall prevalence of UIA was 2.6%. About 28 patients (24.1%) of 116 had unplanned admission. Multiple logistic regression revealed that factors predicting UIA were airway abnormality (odds ratio 16.2, 95% confidence interval 2.65-99.6), anesthetic factors (odds ratio 5.8, 95% confidence interval 1.06-32.2), and hypoxia intraoperative (odds ratio 7.4, 95% confidence interval 1.21-46.24). Procedures on abdomen, emergency surgery, combined anesthesia, and occurrence of intraoperative adverse events were also risk factors for an UIA. Patients with UIA had longer duration of mechanical ventilation than non-UIA patients (4.5 vs. 2 days, p = 0.01), but there were no differences in length of PICU and hospital stays. Preventable adverse events were detected in 25% of U IA children.Conclusions: Airway abnormality, anesthetic factors, and hypoxia intraoperative were risk factors associated with UIA. Although preventable events contribute significantly to unplanned PICU admissions, they constitute a room of opportunity in quality improvement programs.
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Risk factors for severe hemorrhagic cystitis following BMT
(Stockton Press, 1999-01-01) Seber, Adriana [UNIFESP]; Shu, X. O.; Defor, T.; Sencer, S.; Ramsay, N.; Univ Minnesota; Universidade Federal de São Paulo (UNIFESP); Childrens Hlth Care
Hemorrhagic cystitis (HC) is a common toxicity of preparative regimens for bone marrow transplantation (BMT), Severe HC often requires prolonged and expensive hospitalization, and occasionally can result in death. To investigate the risk factors for severe HC, we conducted a retrospective study among 1908 patients who received BMTs at the University of Minnesota during 1974 to 1993, A previous report from our institution reported on 977 of these patients. We identified all patients with genitourinary complication within 100 days post-BMT from the BMT database. Medical charts for these patients were reviewed to determine whether the patient had HC and also the grade of HC, A total of 208 HC cases were identified during the study period. of them, 92 patients had severe HC, an incidence of 5% (95% CI = 4-6%), We found that grade II-IV graft-versus-host disease (RR = 2.56; 95% CI = 1.43-4.56), use of busulfan (RR = 2.69; 95% CI = 1.35-5.35), and age at transplant (RR = 2.20; 95% CI = 1.27-3.81, for age of 10-30 compared to age of 0-9) were related to an increased risk of HC. in contrast, transplant year was inversely associated with the risk of HC (trend test, P < 0.01). We did not find any significant difference in HC with the use of prophylactic Mesna.
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Sequelas auditivas da otite média aguda
(Universidade Federal de São Paulo (UNIFESP), 2015-11-27) Cordeiro, Francisco Polanski [UNIFESP]; Penido, Norma de Oliveira Penido [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Acute otitis media is an inflammatory process in the middle ear, of infectious nature or note, recognized by the Health World Organization as a world problem of public health, for its incidence and prevalence in all of the world. The difficulties to define consensus, most of studies done in pediatric groups and researches regarding complications of chronic otitis may reduce medical attention for a group with sequelae with minor potencial or morbidy, however with a great chance to prevail in daily practice: the sensorial hearing loss post-infeccious. Objective: to stablish and describe the profile of hearing losses in patients with a diagnosis of acute otitis media with clinical and audiological criteria and follow their evolution during 6 months or surveillance. Method: Prospective cohort study with evaluation of the normal contralateral ear as a control, performed between 2014, January and 2015, March, with patients from the Emergency Departament of Hospital São Paulo (Escola Paulista de Medicina ? Universidade Federal de São Paulo), with a diagnosis of unilateral acute middle ear otitis, with five days of evolution, maximum. The patients were evaluated by the anamnesis, physicam examination, conventional audiometry and high frequency audiometry. Results: Even after the normalization of hearing thresholds in the conventional audiometry, there were hearing losses noted in the high-frequency audiometry, mainly in 12500 Hz. The related tinnitus had association with hearing sequelae, even without a complain of hypoacusis. Conclusion: After the treatment of the infection, there was a persistence of hearing losses in the high-frequency audiometry, even with normal thresolds in the conventional audiometry. There is correlation between the existence of tinnitus and the maintenance of hearing loss in high frequencies even after the infection was took over.
Acesso aberto (Open Access)
Sinusite aguda em crianças: estudo retrospectivo de complicações orbitárias
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-02-01) Mekhitarian Neto, Levon; Pignatari, Shirley Shizue Nagata [UNIFESP]; Mitsuda, Sérgio; Fava, Antonio Sérgio; Stamm, Aldo Eden Cassol [UNIFESP]; Hospital Heliópolis; Universidade Federal de São Paulo (UNIFESP); Hospital Prof. Edmundo Vasconcelos
Among the complications of sinusitis, those that involve the orbital region are the most frequent. AIM: the objective of this paper is to show an incidence of orbital cellulites (OC) secondary to acute sinusitis in children. Study design: retrospective. METHODS: After board approval, the charts of all pediatric patients diagnosed with orbital complications secondary to sinusitis, seen at the Pediatric and at the ENT clinics of the HPEV, between 1985 and 2004, were evaluated. The data was analyzed considering gender, age, clinical presentation, period of hospitalization, image study, and treatment. RESULTS: from 1985 to 2004, 25 patients were diagnosed with OC secondary to sinusitis, presenting an incidence of 6% . Males predominated, the median age was 6.5 years, and the maxillary was the most frequently involved sinus. Twenty-four patients presented mild peri-orbital swallowing. All 25 patients presented X-Ray alterations. One patient with proptosis had a subperiosteal abcess seen on the CT-scan. The average time of hospitalization was 4 days. All 25 patients received IV antibiotics, 2 required surgery. CONCLUSION: The incidence of orbital complications secondary to sinusitis is low, and although the majority of cases are early diagnosed and respond well to medication treatment, a surgical intervention may be required.
Acesso aberto (Open Access)
Slipped clip: relato de dois casos
(Academia Brasileira de Neurologia - ABNEURO, 2003-03-01) Melo, Paulo M. Porto de [UNIFESP]; Kadri, Paulo Abdo do Seixo [UNIFESP]; Oliveira, Jean Gonçalves de [UNIFESP]; Braga, Fernando Menezes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Aneurysm rest occurs in 1 to 10% of operated patients and of these, 21.8% are due to slipped clips. D´Angelo and coworker (1998) found 1 to 10% of residual aneurysms. They suggest that if the residual aneurysm has less than 2 mm, angiographic control must be performed after 3-5 years of the surgical procedure; if between 2 and 4 mm, the angiographic control must be done in the first 6 months after surgery and then, anually. If it has more than 4mm a direct surgical approach is advised. We present the cases of two female patients submitted to microsurgical treatment of intracranial aneurysm, without any intra-operative abnormal event. The angiographic study further made showed displacement of the clip from its original position and aneurysm again. A review of the literature is also presented.
Acesso aberto (Open Access)
O tratamento da laringomalácia: experiência em 22 casos
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-06-01) Avelino, Melissa Ameloti Gomes [UNIFESP]; Liriano, Raquel Ysabel Guzmán [UNIFESP]; Fujita, Reginaldo Raimundo [UNIFESP]; Pignatari, Shirley Shizue Nagata [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Laryngomalacia is the most frequent cause of stridor in childhood, and in most of the cases, spontaneous resolution occurs by the age of 2 years. Approximately 10% of the cases (severe laryngomalacia) require surgery. This condition is of unknown etiology and its diagnosis is made by fiberoptic laryngoscopy, which shows shortening of the aryepiglottic folds, and/or redundant arytenoid mucosa, and/or anterior-posterior epiglottic prolapse. AIM: Our objective was to verify the main clinical and anatomical affections and to highlight the clinical parameters for clinical follow-up and surgical indication in patients with laryngomalacia. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: Twenty-two children diagnosed with laryngomalacia in the Pediatric Otorhinolaryngology of UNIFESP-EPM, from January 2001 to December 2003, whose clinical and surgical follow-up were performed by the same examiner, were enrolled in this study. RESULTS: Out of twenty-two evaluated children, 2 (9.1%) presented with severe laryngomalacia and pectus excavatum (funnel chest). At polysomnography, no child presented any significant respiratory event during sleeping. Those two children with severe laryngomalacia were submitted to supraglottoplasty with resection of the aryepiglottic folds. CONCLUSION: We concluded that stridor and shortening of the aryepiglottic folds are preponderant in children with laryngomalacia. The polysomnographic exam did not prove to be a good parameter for clinical follow-up, neither for surgical indication. The most important parameters were pectus excavatum and failure to thrive. Supraglottoplasty is effective and has low morbidity rate.
Acesso aberto (Open Access)
Trombose do seio sigmóide associada à otite média crônica
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-04-01) Penido, Norma de Oliveira [UNIFESP]; Toledo, Ronaldo Nunes [UNIFESP]; Silveira, Paula Angélica Lorenzon [UNIFESP]; Munhoz, Mário Sérgio Lei [UNIFESP]; Testa, Jose Ricardo Gurgel [UNIFESP]; Cruz, Oswaldo Laércio Mendonça [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Otogenous lateral sinus thrombosis (OLST) is a rare disease and presents a controversial treatment. AIM: Clinical aspects and treatment were reported based on our experience. METHODS: Retrospective study. Six cases of OLST were treated in our institution in the last ten years. Clinical and imaging data were analyzed. RESULTS: All six patients had the lateral sinus thrombosis detected during image evaluation for other symptoms related to chronic otitis media (COM) complications. Fever, headache and facial paralysis were the main clinical manifestation related to mastoiditis, meningitis and cerebellar abscess. We could not identify, in any case, specific features of lateral sinus thrombosis. In all cases a mastoidectomy was associated with large spectrum antibiotics maintained for 3 months. In three cases anticoagulation therapy was introduced and in three cases anticoagulation was not indicated. All cases presented a good clinical evolution, without sequelae. CONCLUSIONS: OLST is almost always associated with other complications of COM. It is diagnosed almost by accident during the investigative image study. We believe such disease is underestimated. In our experience, OLST presents a benign course, and mastoidectomy with antibiotics is the treatment of choice.

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