GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdevel...GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.展开更多
Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a p...Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.展开更多
Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the mo...Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments;however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility (p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.展开更多
文摘GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.
文摘Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.
文摘Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments;however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility (p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.
