Our aim is to describe the specific care for people with pharingostoma and esophagostoma, drivers of improving clinical practice and the quality of life of patients. Surgeries such as total laryngectomy instigate a huge physical, social and emotional impact on the person and family, whose consequences and possible complications are enhanced when accompanied by the confection of a pharingostoma and esophagostoma. The person with pharingostoma and esophagostoma requires differentiated care that includes the dressing, surveillance and specific care, not forgetting the care inherent to the respiratoryostomy, as well as all other dimensions of the person (psychological, social, cultural and spiritual). In view of all the surgical complexity, people with these specific types of stomas require specialized nursing interventions, based on evidence, to prevent complications and to improve their quality of life, thereby justifying the need for intervention by the entire multidisciplinary team.

Paragangliomas (PGLs) are neuroendocrine neoplasms that can occur throughout the body wherever there is paraganglia. Representing 0.03% of all tumours, PGLs are extremely rare. Although predominantly benign and amenable to cure by surgical ressection, up to 6% can be malignant. To date, three genes have been identified that are associated with Familial PGLs. All three encode subunits (D, B and C) of the enzyme succinate dehydrogenase complex (SDH), which is part of the Kreb's cycle and the electron transport chain. We report a novel causative frameshift mutation in the subunit D of SDH (SDHD) in a family with Carotid Body Paragangliomas. This finding contributes for extending the known mutational spectrum of SDHD, and to help the genetic counseling of this family. Noteworthy, is now possible to offer to other relatives, still sub-clinical, a predictive test that would eventually aid an early surveillance/intervention for a better prognosis.

Introduction: Representing 0.03% of all tumors, paragangliomas (PGLs) are extremely rare. During the past 15 years, there has been a significant progress in the knowledge of the genetics of PGLs. Germline mutations in succinate dehy- drogenase (SDH) genes are the commonest genetic cause of PGL. Objective: Given the high clinical relevance of the SDH status, we aimed to evaluate the diagnostic and prognostic value of SDH mutations in a Portuguese cohort with carotid body paragangliomas.We Report the experience of several departments of Angiology and Vascular Surgery in the management of carotid body tumors. Methods: Forty-six individuals were included in the present study, of which forty-two were index cases and four were familial cases. Clinical features and biochemical data were retrieved by a retrospective analysis of clinical files. DNA was isolated from peripheral blood samples obtained from all individuals following their written informed consent. For all the subjects recruited, the genetic analysis involved the mutation search on the entire coding region of the SDHD gene and was extended to the SDHB gene coding region, in a subgroup of patients with a more aggressive presentation. Results: Since 2016, genetic screening was offered to 46 patients with Carotid body PGL. The patients came from Angiology and Vascular Surgery Departments from all over the country.The genetic analysis identified seven different heterozygous mutations in the SDHD gene (p.Met1Val, p.Met1Ile, p.Gly12Ser, p.Pro53Leu, IVS3+4G>A, IVS3-2A>C, p.Leu139Phefs)In addition, one mutation in SDHB gene (p.Ser198Alafs) was present in one index case. The SDHD mutations were identified in eight of the 41 index patients (20%), and in three of the four familial cases studied (75%). Of these, one mutation, p.Met1Ile, was present in two apparently unrelated patients. The prevalence of the Familial type has varied between reported studies from as low as 5% to as high as 30%, in our study they represent 26% (12 cases) of the sample. This wide-ranging variability stems from the existence of hidden familial cases. Conclusion: Genetic screening allows the identification of familial cases and improves clinical decision-making and adequate management of patients and their relatives. The Present data contributes to a broader characterization of the molecular profile of European patients with PGL.

This study aimed to evaluate the viability of the decellularization process in bovine cartilaginous tissue by histological analysis. For this purpose, 20 bovine elastic cartilages were used, immersed in alkaline solution for 72 hours, followed by washing, freezing and lyophilization of the material. Histological processing was then performed to perform the analyzes. In the histological analyzes the decellularization and removal of the amorphous substance from the tissue was observed, but the structure of elastic fibers and collagen remained. It was concluded that the alkaline treatment was efficient to obtain biomaterial from elastic cartilaginous tissue. This study also evaluated, through thermographic examination, the feasibility of using implants with biomaterials obtained from elastic cartilages treated in alkaline solution. The intensity of the inflammatory process was observed through the variation of cutaneous temperature comparing before and after the implantation of the biomaterials in rabbits (Oryctolagus cuniculus). A total of 24 rabbits were evaluated, divided into two groups, of 12 animals each, according to the implanted biomaterial. Evaluations were performed in the preoperative period and after the implantation of biomaterials. In the (GI) group, polypropylene mesh and elastic cartilage (GII) were treated with alkaline solution, evaluated in the periods of seven and 35 days. From the results obtained, after performing statistical tests, the group (GI) polypropylene mesh, obtained upper abdominal skin temperatures, compared to the cartilage group, providing subsidies that the use of elastic cartilage treated in alkaline solution, promoted lower inflammatory intensity due to the processing to which it was submitted. It is concluded that treated elastic cartilage has been shown to be a superior biomaterial relative to the mesh polypropylene.

The advancement of the Family Health Strategy was a gradual process and were numerous the results achieved as to reducing child mortality, reducing hospitalizations by conditions sensitive to Primary Health Care and the improvement of socio-economic indicators of the population. However, we must emphasize that the service performed depends on a rear of medium complexity, and tests of high complexity, with procedures and diagnostic purpose elective surgical procedures. In this sense, the completion of the main proposal "provision of health services" suffers the action of different variables, being the health service's regulation a way to mediate the existing demand with the supply of services, with the capacity to intervene promptly as a mediator in the process leading up to the final act. In relation to the elective surgeries in Goiânia, observed numerous cases that the medical professional of the FHS, due to lack of standards or guidelines, has had difficulties in defining the form that the patient should continue its assistance in the health system in cases that is concluded a diagnosis which indicates a surgical treatment. When evaluate the need of improvements in the services provided by the FHS, with the demand of the Organization and operation of networks and flows combined with policies of support and stimulus to expand the user's access by Health Ministry this study proposes a requesting protocol of elective surgeries by medical professionals of the FHS.

Objective: to investigate the profile of cancellation of surgeries in a public teaching hospital. Method: retrospective, descriptive, quantitative study performed at the Surgical Center unit of a public teaching hospital, located in the city of Goiânia-GO, Brazil. This surgical center consists of 11 operating rooms and 01 anesthetic recovery room with 7 beds. In the institution, approximately 4,400 surgeries per year are performed: bucomaxillofacial, cardiac, general, plastic, coloproctology, gynecology, mastology, neuro, otorhinolaryngology, orthopedics, thoracic, urology and vascular. Surgery cancellation data were collected between May and July 2017, related to the year 2016, using as a research source the surgical warnings, hospital data computerization system and nursing reports. The data were computed in spreadsheets and divided into two factors: structural, like the incomplete surgical team and process, such as the change in medical conduct. The information collected was analyzed descriptively and through the chi-square test in STATA® (14.0). Results: in 2016, 4,423 surgeries were performed, 2,885 (74.95%) were elective and 1,538 (87.74%) were emergency / emergency. Of these, 1,179 (21.05%) were canceled. The specialties that presented the highest frequency of cancellation were orthopedics / traumatology (30.79%), otorhinolaryngology (16.11%) and general surgery (15.35%). Among the reasons for cancellation, 67.35% were related to the processes; 20.19%, due to lack of hospitalization; 12.46% patient without clinical conditions. Other reasons were related to the structure, 32.65%, standing out 7.46%, technical problems in the material center and sterilization. Conclusion: Most of the surgeries were canceled due to patient-related reasons, related to the process and not to the hospital unit, therefore considered avoidable. These data are of great relevance in the aid of an institutional planning, since, to minimize cancellations, implies to guarantee a higher quality in the health and safety services of the patient, as well as the rational use of human and financial resources.

INTRODUCTION: Evidence shows that out of every ten people in the world, one has been the victim of medical errors or preventable adverse events. These statistics are further evidence that of the 234 million patients undergoing surgeries, seven million suffer postoperative complications, increasing mortality rates by around 0.4 to 10%. A surgical site infection is considered the second highest incidence of major impact to the morbidity and mortality of patients, and may cause irreparable physical and emotional harm, as well as increase the cost of therapy for institutions. This reality drove the Safe Surgery Saves Lives program, which is the second Global Challenge for the World Alliance for Patient Safety program, launched by the World Health Organization in 2004. Studies organized by the National Health Surveillance Agency of Brazil, derived from these campaigns, cataloged nine process indicators to prevent these infections, which were the subject of this investigation. OBJECTIVE: To examine the process indicators for the prevention of surgical site infection in the perioperative period in patients undergoing clean surgery in a teaching hospital in central-western Brazil. METHODS: Retrospective analytical cohort study, conducted in 700 records of patients aged 18 years or older undergoing clean surgical procedures from January 2008 to December 2010. We used a structured form, previously evaluated according to national guidelines. Data were entered into SPSS version 15 for Windows. The analysis was descriptive and multivariate, and used chi-square tests, Fisher, and odds ratio (OR) as measures of association for variables with p <0.10. Statistically significant associations with p <0.05 were considered. RESULTS: Regarding the socio-demographic profile of the patients, 57.1% were female, aged between 18 and 101 years, 39.3% had comorbidities, 74.5% with ASA ≤ II. Regarding surgical specialty, 29.9% were orthopedic and 19.9% were vascular. Nonconforming indicators were found in 64.6%. Aspects such as the time of preoperative hospitalization, the method used for hair removal, the duration of antimicrobial prophylaxis, glycemic control in diabetics, as well as the thermal controls and inspection records of the surgical cases were not considered appropriate. The predictors for surgical site infection in the univariate analysis were male gender, carriers of chronic disease, alcoholism and smoking, infections already present on admission, a length of preoperative hospital stay of greater than 5 days, ASA ≥ III, shaving and antimicrobial prophylaxis; the independent factors were: being a carrier of a chronic disease, infections already present on admission and shaving with a razor blade. The estimated rate of infection was 10%. The surgical specialty with the highest rate of infection was vascular, with 25.9%. The methicillin-resistant Staphylococcus aureus was the most evident causative agent. CONCLUSION: We conclude that the service partially meets the process indicators for the prevention of surgical site infection in the perioperative period of clean surgeries, incongruent with the principles of the Safe Surgery Saves Lives program.

Cataracts is the treatable eye diseases that cause most blindness in the world. The effective treatment is surgical and phacoemulsification the most applied technique. Some complications are associated with the procedure as corneal opacities, uveitis and fibrin deposits. The presence of fibrin in the anterior chamber is associated with the formation of synechia and secondary glaucoma low visual recovery of patients. Some medications, as TPA (Tissue Plasminogen Activator) which acts in the degradation of fibrin, seeing being used to soften these deposits. Tenecteplase is a third generation of the synthetic TPA and have a longer half-life than the others with application in ophthalmology without damage to the cornea and retina of rabbits and humans. The study was conducted on 15 rabbits of New Zealand race, share in three groups GC, GT and GNT. The GNT and GT were surgery by phacoemulsification technics, GT was treated with 0.1 ml intracameral tenecteplase (50 μg) transoperative. The rabbits were evaluated in M0 moments - when selected, underwent phacoemulsification surgery and reassessed in M1d – 1th day M3d – 3th day M7d – 7th day M15d - 15th day and M21d – 21th days. In the clinical evaluation of the use of intracameral tenecteplase in transoperative and postoperative complications were observed, emphasizing the change in IOP, the corneal edema, fibrin deposits, hyphema, aqueous flare and synechia incidences. In the M21d animals were sacrificed, and samples of aqueous humor were collected for physical-chemical analysis (pH, density, concentration of chloride ions and total proteins). No statistical differences were observed in the clinical evaluation of the GC and GNT within the recommended parameters. In physical-chemical analysis of aqueous humor showed no statistical difference between the three groups in terms of pH and concentration of chloride ion. The density values and total protein concentration between the GC and the other groups.

Embora a cirurgia de avanço mandibular seja considerada um procedimento altamente estável, existem algumas preocupações clínicas em relação a mudanças nos côndilos e nos segmentos proximais, que podem levar a recidiva sagital e abertura de mordida. A avaliação dos resultados da cirurgia através de ferramentas de geração e superposição de modelos virtuais tridimensionais (3D) permite a identificação e quantificação dos deslocamentos e remodelação óssea que podem ajudar a explicar as interações entre os componentes dentários, esqueléticos e de tecido mole que estão relacionados a resposta ao tratamento. Este estudo observacional prospectivo avaliou, através de tomografia computadorizada de feixe cônico (CBCT), mudanças na posição/remodelação 3D dos ramos mandibulares, côndilos e mento. Assim, exames CBCT de 27 pacientes foram adquiridos antes da cirurgia (T1), imediatamente após a cirurgia(T2), e 1 ano após a cirurgia(T3). Uma técnica automática de superposição na base do crânio foi utilizada para permitir a avaliação das mudanças ocorridas nas regiões anatômicas de interesse (RAI). Os deslocamentos foram visualizados e quantificados em mapas coloridos 3D através da ferramenta de linha de contorno (ISOLINE). Pelo teste t pareado compararam-se as mudanças entre T1-T2 e T2-T3. O coeficiente de correlação de Pearson verificou se os deslocamentos ocorridos nas RAI foram correlacionados entre si e entre os tempos de avaliação. O nível de significância foi determinado em 0,05. O avanço mandibular médio foi de 6,81±3,2mm em T2 e 6,36±3,41mm em T3 (p=0,13). Entre T2 e T3, a posição do mento variou positivamente (&#8805;2mm) em 5 pacientes negativamente em 7. 12% dos pacientes sofreram recidivas &#8805;4mm. Para todas as outras RAI avaliadas, apenas a porção inferior dos ramos (lado direito - 2,34±2,35mm e lado esquerdo 2,97±2,71mm) sofreram deslocamentos médios >2mm com a cirurgia. No acompanhamento em longo prazo, esse deslocamento lateral da porção inferior dos ramos foi mantido (lado direito - 2,10±2,15mm, p=0,26; e lado esquerdo -2,76±2,80, p=0,46), bem como todos os outros deslocamentos observados (p>0,05). As mudanças na posição do mento foram correlacionadas a adaptações pós-cirúrgicas nos bordos posteriores dos ramos (esquerdo r=-0,73 e direito r=-0,68) e côndilos (esquerdo r=-0,53 e direito r=-0,46). Os deslocamentos médios sofridos pelas estruturas do lado esquerdo foram suavemente maiores do que no direito. Correlações dos deslocamentos ocorridos entre T1-T2 e T2-T3 mostraram que: os deslocamentos dos côndilos esquerdos com a cirurgia foram negativamente correlacionados às adaptações pós-cirúrgicas destes (r=-0,51); e que o deslocamento da porção superior do ramo esquerdo com a cirurgia foi correlacionado à adaptação pós-cirúrgica ocorrida nos bordos posteriores (r=0,39) e côndilos do mesmo lado (r=0,39). Pode-se concluir que: (1) os deslocamentos causados pela cirurgia foram de modo geral estáveis no acompanhamento de 1 ano, mas identificou-se uma considerável variação individual; (2) as mudanças pós-cirúrgicas na posição do mento foram correlacionadas a adaptações sofridas pelos côndilos e bordos posteriores dos ramos; e que (3) deslocamentos suavemente maiores causados pela cirurgia nas estruturas do lado esquerdo levaram a maiores adaptações pós-cirúrgicas no segmento proximal deste lado.

A doença de Peyronie atinge 9% da população adulta masculina e seu tratamento, quando há deformidade significativa, é cirúrgico. A cirurgia capaz de corrigir desvios complexos (multiplanares e ampulheta) prevenindo a perda do tamanho peniano é a incisão da placa e enxertia; porém apresenta maior incidência de disfunção sexual erétil (DSE). No intuito de compreender melhor as consequências mecânicas e geométricas da cirurgia de enxertia foram recriadas as técnicas cirúrgicas mais comuns, utilizando um modelo tridimensional de cilindro. Evidenciou-se imprecisões geométricas e problemas mecânicos significativos. Desta forma A DSE pós-operatória pode estar ligada às alterações geométricas e mecânicas secundárias à enxertia. Em uma segunda fase da pesquisa, usando nosso modelo de tortuosidade peniana de tecido de algodão, criamos uma solução matemática para incisão da placa e enxertia sem defeitos residuais. A solução foi usada em 9 homens, que possuíam rigidez peniana suficiente para penetrar a parceira. Eles foram submetidos à corporoplastia com enxerto de fáscia lata, usando a nossa nova técnica, calculada por um aplicativo para o iPad. Aplicamos a versão de 5 itens do índice internacional de função erétil (IIEF-5) no pré-operatório e ao fim do acompanhamento. Após um acompanhamento médio de 16 meses nenhuma complicação significante foi observada no pós-operatório recente. A retificação completa peniana foi alcançada em 100% dos pacientes. A média de aumento no lado curto peniano foi de 3 cm e a área média do enxerto de 12.4cm2. Ao fim do acompanhamento 33% dos pacientes desenvolveram recorrência da deformidade. Um paciente (11%) apresentou intensa fibrose no corpo cavernoso e disfunção erétil (DE) severa. A média do IIEF-5 pós-operatório foi de 19.4, sem diferença estatística significante do período pré-operatório (20.4). Ao fim do acompanhamento todos os pacientes eram capazes de ter intercurso sexual, 2 (22%) pacientes com ajuda farmacológica e 7 (77%) sem ajuda. 89% dos pacientes ficaram satisfeitos com a cirurgia. Podemos concluir que a correção cirúrgica da curvatura peniana com o uso do iGrafter parece ser segura e eficiente na retificação peniana, sem provocar nenhuma deformidade residual e com uma área mínima. Mais estudos de longo prazo são necessários para confirmar estes achados.