Hyperbaric oxygen therapy (HBOT) is defined as a treatment mode which involves the breathing of pure oxygen (100% O2) at an ambient pressure higher than the atmospheric one measured at the sea level.The treatments are performed with the patients breathing pure oxygen, entirely enclosed in sealed chambers, pressurized with air (multiplace chambers) or with oxygen (monoplace chambers), at a pressure greater than one atmosphere. Multiple physiological mechanisms, which are activated as a result of hyperbaric oxygenation (mechanical effect of increased pressure, toxic gas increased wash out, hyperoxygenation, vasoconstriction, fibroblast proliferation, angiogenesis, leukocyte oxidative bacterial killing, toxin inhibition, bacteriostasis, bacterial killing, antibiotic synergy) explain the many beneficial effects of HBOT in several pathological conditions, caused, worsened or perpetuated by hypoxia or gas bubbles trapped in the body, such as: decompression sickness, air embolus syndrome, carbon monoxide intoxication and acute cyanide poisoning, clostridial gas gangrene, necrotizing soft-tissue infections, chronic osteomyelitis, chronic wounds, radiation-induced injury, crush injuries, compartment syndrome, graft and flap salvage, oedema, sepsis, acute burns, severe blood loss anemia, and many others.The present work provides an overview concerning some historical aspects, physiological effects, clinical applications, and secondary effects of HBOT.

ln the last years, newly lymphoid neoplasms werw recognized with clinical, morphologic and immunophenotypic characteristics distinct from the common  forms described in the Working Formulation. One of the newly variant oflymphoma recently recognized were the mantle cell lymphoma in 1992. Case report: the authors reporta case of 73-year­ old man admitted in our deparrtment with symptomatic anemia, poor performance status, generalized lymphadenopathy, splenomegaly and lymphocitosis in the blood peripherial. He presented a elevated lactate dehydrogenase and b2 microglobulin levels. After evaluation of disease, that included bone marrow biopsy, immunophenotypic stdies of blood marrow, lymph node biopsy, chest-abdomen-pelvic computed tomographic scan, we made the diagnosis of diffuse mantle cell lymphoma, stage IV of Ann Arbor staging classification. made a gastrointestinal endoscopy that revealed multiple nodules in stmach and duodenal bulb which histologic findings shows a diffuse envolvement by lymphomatous B cells. The patient was treated until now, with four cycles of cyclophosphamide, vincristine, mitoxantrone and prednisone with partial remission after reavaluation. We review the literature about this subject.

Background: We analysed epidemiological data,therapies, clini­cal efficacy and evolution of patientes with adult idio­pathic thrombocytopaenic purpura (ITP). Patients and methods: A retrospective study of patients with an established diagnosis of ITP, referred to our lnternal Medical Department between 1991 and 1995, was carried out. Dejinitlons of therapy efficacy and evolution are as follows.· complete remisson platelets > 150000/mm3; continuous complete remission: platelets >150000/mm3 for at least 2 months without therapy partial remissi­on: platelets >50000< 150000/mm3; without therapy response<50000/mm3. Results: Between 1991 and 1995, 30 patients were admit­ ted with IPT ( 23female; 7male; median ages: 49,5 years). Corticosteroid therapy was given to 30 pa­tients, 9 achived complete remission; 4 of those were in continuous complete remission; 15 patients had partial remission and 6 failed to achieve a respon­se. 14 patients received gammaglobins intra-venously; 1 achived complete remission; 9 had parti­al remission and 6 had no response. Only 4 patients were splenectomized; 2 achi­ved complete remission; other were lost for to follow-up. Four patients were treated with azothioprine; 3 achi­ved partial remission and 1 patient had no response. Danazol was used in 2 patients with no beneftcial effect.. Median follow-up for 24 months revealed: 13 patients had multiple relapses, 4 achieved continuous complete remission and 1 died; 12 pati­ents were lost to follow-up. Conclusions: Corticosteroid therapy was the most effective therapy in ITP, with 30% of pattents achieving com­plete remisston in our study. ln spite of the many different treatment regi­mes available, 43% of patients had a chronic disease evolution, in accord with the international ITP disease statistics.

Metastases are the commonest extradural tu­mors leading to spinal cord compression at mul­tiple leveis. This is a retrospective study of 209 patients admited at our hospital (Neurology and Neurosurgery departments and outpatient con­sultation) between 1989 and June of 1996 with metastatic spinal cord tumors. Sex and age, neu­rologic presentation, neuroradiologic findings, primary tumour origin, terapeutic approaches and outcome were evaluated in ali patients. Our main purpose with this review was to establish the most frequent clinical presentation that would permit a very fast diagnosis and treatment with a favourable outcome.

Aortic aneurysms affect 3.3% of adults and there is a growing burden of small aneurysms detected, which may grow to need surgical repair. Still, we rely only on surgical therapy for this disease, left to monitor patients until they are candidates for treatment. Pharmacologic therapies have long been proposed and studied and still we have no evidence supporting drug therapy in small aneurysms. In this report we make a narrative review of basic molecular aspects of aneurysm disease and of evidence behind drug therapies that have been proposed and studied throughout the last decades.

Adherence to antiretroviral therapy reduces the risk of treatment failure, toxicity and resistance, so the therapeutic monitoring is necessary in the treatment of infection by human immunodeficiency virus. The aim of this study was to determine, through clinical and laboratory studies, the compliance of individuals sickened by HIV / AIDS with antiretroviral therapy before and after three nursing interventions. The study design was analytical, descriptive, prospective and quantitative, using data from medical records, interviews and blood sampling for plasma levels of efavirenz by HPLC analysis, including subjects with a diagnosis of HIV / AIDS, attended at the Hospital for Diseases Tropical Goiânia - Goiás and treated with zidovudine/ lamivudine and efavirenz. The results of analysis of data from 15 subjects indicate a socio-demographic profile, predominantly male, young, heterosexual. After nursing intervention, there was a change in 48% of the diagnoses. We also noticed a positive change in the rates of CD4, corresponding to 14%. As viral count, an increase of subjects with undetectable loads of 1 st to 2 nd nursing intervention (20%, or 73.3% to 93.3%). Chromatographic analysis of plasma of the subjects indicated that 60% of them had adequate medication adherence, and 40% increased adhesion between the 1st and 2nd visits by nurses, 10% between the 1st and 3rd and 10% between the 2nd and 3rd queries. The factor that was associated with high concentration rate after adjustment in nursing diagnoses and prescriptions was having difficulty using the antiretroviral in the same time. It was also demonstrated significant difference between mean plasma concentrations of efavirenz from the 1st, 2nd and 3rd interventions. Considering the reference measurement of plasma concentrations of efavirenz, the method of accession had a sensitivity and specificity, with high proportion of agreement between the rate of CD4, nursing diagnosis and analysis of the plasma of subjects. Conclusions: the systematization of nursing care and determination of plasma concentrations should be incorporated into the routine outpatient care, for better monitoring of adherence to antiretroviral therapy of individuals sickened by HIV / AIDS.

OBJECTIVES: To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS: Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS: The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30–0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16–2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08–1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40–0.59, p ≤ 0.001). CONCLUSIONS: The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

BACKGROUND: Lukoff¹ advanced religious/spiritual problems as conditions that may be the focus of therapy. One such problem/condition has been termed spiritual emergence². OBJECTIVES: This case study explored the role of dreams and images in spiritual emergence processes. METHODS: Methodology involved a single case study and a literature review. Sources of data included six cases, reduced to three that exemplified contemporary experiences of spiritual emergence and/or spiritual emergency, and further limited to a single case due to space constraints. Similarities and differences between the case and literature were used in interpreting the role of dreams and dream-like experiences in spiritual emergence processes. Data spanned written, semi-structured interviews, published literature, historical documents, biographical narratives, and content analysis. Analysis included thematic, conceptual, and descriptive methods. Comparison of the case with findings from the literature review helped identify and validate various roles of dreams and images. RESULTS: A primary role of dreams and images in spiritual emergence seems to be to act as signs, with secondary roles as providing direction, or at least information. DISCUSSION: Implications of the findings are supportably applicable to spiritually emerging populations and to therapy where dream work is used.

CONTEXT: Several practices that include the family in a psychiatric institution were investigated. The focus was on the multifamily group, which is a privileged space for assistance. GOAL: There was an attempt to understand how families are assisted, raising the main questions observed in different groups. METHODS: Participant observation was conducted in the child and youth sector, the Day-Hospital, the Center for Alzheimer Disease and other dementia (CDA), and in the Program for Studies and Assistance in Inappropriate Use of Drugs (PROJAD). RESULTS: It was observed that in the multifamily group the catharsis, the account of conflicts and the sharing of information produce a network effect. Family members work together, and families engage in a conversation that helps building a supportive community. DISCUSSION: In the face of the questions raised, it is important to discuss multifamily group, relating it to multifamily group therapy, groups of psychoeducation, and to the work in social networks. It was concluded that the routine in a psychiatric institution has been including the family, but it is necessary to analyze the demands and systematize the assistance conducted with groups.

The pratice of Physical therapy in Brazil has expanded a lot since its implantation at the beginning of the century and plenty of services have been created. Due to muscle changes that have been passed away from de circulatory disturbance, there was the necessity of its implantation in the vascular surgery and Angiology area. As chronic venous insufficiency is a pathology that causes functional incapacity and possible change of daily life activities, physical therapy through the kinesiotherapy, respiratory exercises and a global mobilization has an important function in the rehabilitation of patients. Ten female patients with chronic venous insufficiency were evaluated and submitted to kinesiotherapy. Parameters pain, range of motion and oedema before and after treatment were compared. The results suggested the control of pain, oedema and range of motion in our patients, showing that physical therapy can be an important way for treating theses patients.