The aim of this thesis was to find out how much and in what way children are prepared for surgical procedures. For the research were selected children at the Department of Paediatric Surgery of the Kolín Regional Hospital, from February to June 2018. In the theoretical part, risk factors for developing anxiety disorders in childhood are described. In particular, anxiety and nervousness, fear, phobia, situational anxiety and mental resilience are defined. A mixed method was used in the research. The main tool was a written questionnaire. In the case of unclear answers, an oral interview was used. In the practical part, two types of questionnaires were used. One is for hospitalized children aged 7-15 and the other for their parents. The research found that seventeen children, out of seventy, were not informed at all, or immediately before surgery. All these children were restless, or even hysterical, they were screaming and crying. The children who were informed of the operation in some way tolerated it quite well. So we can say that most of the children were prepared. Mostly it was only by conversation with parents. The educational material was not used because there is not currently appropriate one.

INTRODUÇÃO: Embora a craniotomia pterional e suas variantes sejam os acessos mais utilizados em neurocirurgia, poucos estudos analisaram de forma quantitativa a exposição fornecida em cada uma delas. OBJETIVOS: Neste estudo, realizou-se avaliação comparativa das exposições cirúrgicas fornecidas pelas craniotomias pterional (PT), pré-temporal (PreT) e orbitozigomática (OZ) por meio de medidas quantitativas da área de exposição cirúrgica ao redor círculo arterial do cérebro, exposição angular e exposição linear da artéria basilar na fossa interpeduncular e cisterna pré-pontina. MÉTODOS: Oito cadáveres adultos frescos, com tempo máximo de 24 horas após a morte, foram utilizados no estudo. As craniotomias foram realizadas sequencialmente no mesmo cadáver, em um único lado, iniciando-se com a PT, seguido da PreT e terminando com a OZ. Após cada craniotomia, calculou-se a área de exposição cirúrgica, delimitada pelos seguintes pontos: (1) ponto mais lateral da fissura orbitária superior ipsilateral; (2) bifurcação da artéria cerebral média (ACM) ipsilateral; (3) ponto mais distal da artéria cerebral posterior (ACP) ipsilateral; (4) ponto mais distal da ACP contralateral; (5) ponto mais distal da ACM contralateral; (6) ponto mais lateral na asa menor do esfenoide contralateral. Calculou-se ainda, após cada craniotomia, a exposição angular nos eixos horizontal e vertical das seguintes estruturas vasculares: (1) bifurcação da ACM ipsilateral; (2) bifurcação da artéria carótida interna (ACI) ipsilateral; (3) topo da artéria basilar; (4) ponto médio da artéria comunicante anterior; (5) bifurcação da ACI contralateral; (6) ponto mais distal da ACM contralateral. Por fim, após cada craniotomia, mediu-se a exposição linear da artéria basilar na fossa interpeduncular e cisterna pré-pontina. Todas as aferições foram feitas utilizando-se um sistema de neuronavegação computadorizado. RESULTADOS: A OZ apresentou maior exposição cirúrgica em torno do círculo arterial do cérebro (PT = 844,7 ± 233,3 mm2; PreT = 1.134 ± 223,3 mm2; OZ = 1.301,3 ± 215,9 mm2) com aumento de 456,7 mm2 em relação à PT (p < 0,01) e de 167,4 mm2 comparado com a PreT (p < 0,05). A exposição linear da artéria basilar aumentou significativamente com a extensão da craniotomia PT para a PreT e sequencialmente para a OZ. A extensão da PT para PreT e OZ aumentou a exposição angular em todas as medições. Ao compararmos as craniotomias PreT e OZ encontramos um aumento na exposição angular horizontal do topo da artéria basilar (p = 0,02) e bifurcação da artéria carótida interna contralateral (p = 0,048). CONCLUSÕES: A craniotomia OZ oferece vantagens cirúrgicas significativas em relação à PT e PreT, no que diz respeito à área de exposição cirúrgica e exposição linear da artéria basilar. A remoção de parte da margem orbital e do arco zigomático forneceu aumento significativo da exposição angular, proporcionando maior liberdade cirúrgica para acessar estruturas da fossa interpeduncular, cisterna pré-pontina e cisternas subaracnóideas contralaterais. Os dados apresentados no estudo, somados à experiência do cirurgião podem auxiliar na escolha do melhor acesso cirúrgico para cada lesão a ser tratada / INTRODUCTION: Although pterional craniotomy and its variants are the most used approaches in neurosurgery, few studies have analyzed quantitatively the exposure provided by each of them. OBJECTIVES: In this study we compared the surgical exposures provided by pterional (PT), pretemporal (PreT) and orbitozygomatic (OZ) approaches through quantitative measurements of area of surgical exposure around the circle of Willis, angular exposures, and linear exposure of basilar artery in the interpeduncular fossa and prepontine cistern. METHODS: Eight adult fresh cadavers were used within 24 hours after death. The craniotomies were sequentially performed in the same cadaver, first starting with the PT, followed by the PreT, ending up with the OZ. After each craniotomy the area of surgical exposure was calculated, delimited by the following points: (1) lateral aspect of the superior orbital fissure in the ipsilateral sphenoid wing; (2) bifurcation of ipsilateral middle cerebral artery (MCA); (3) most posterior visible point of the ipsilateral posterior cerebral artery (PCA); (4) most posterior visible point of the contralateral PCA; (5) most distal visible point of the contralateral MCA; (6) most lateral visible point of the contralateral lesser sphenoid wing. After each craniotomy, the angular exposure in the horizontal and vertical axes of the following vascular structures was calculated: (1) bifurcation of the ipsilateral MCA; (2) bifurcation of the ipsilateral internal carotid artery (ICA); (3) basilar artery tip; (4) middle point of anterior communicating artery; (5) bifurcation of the contralateral ICA; (6) most distal point of the contralateral MCA. Finally, after each craniotomy, linear exposure of the basilar artery was measured in the interpeduncular fossa and prepontine cistern. All measurements were performed using a computerized neuronavigation system. RESULTS: OZ presented a wider surgical exposure of the circle of Willis (PT = 844.7 ± 233.3 mm2; PreT = 1134 ± 223.3 mm2; OZ = 1301.3 ± 215.9 mm2) with an increase of 456.7 mm2 in relation to the PT (p < 0.01) and of 167.4 mm2 to the PreT (p < 0.05). The linear exposure of the basilar artery significantly increased with the craniotomy extension to the PreT and then to OZ. The extension from PT to PreT and OZ increases angles in all measurements. When comparing the PreT and OZ we found an increase in the horizontal angular exposure to the basilar tip (p = 0.02) and contralateral ICA bifurcation (p = 0.048). CONCLUSIONS: The OZ approach offered significant surgical advantages compared to the traditional PT and PreT regarding to the area of exposure and linear exposure to basilar artery. With regards to the angular exposure, the orbital rim and zygomatic arch removal provided greater surgical freedom to access structures of the interpeduncular fossa, prepontine cistern, and contralateral subarachnoid cisterns. The data presented in the study added to the experience of the surgeon can help in choosing the best individualized surgical approach

Introdução: A radiologia intervencionista utiliza técnicas endovasculares minimamente invasivas para se estancar hemorragias, em cenários clínicos relacionados ao trauma. O objetivo destas técnicas é conter o sangramento de forma rápida e eficaz, sem o estresse fisiológico determinado pela cirurgia aberta. Neste contexto, esta modalidade terapêutica foi descrita pela primeira vez em 1977(1), no tratamento de trauma abdominal fechado com sangramento por lesão hepática. Desde então as técnicas endovasculares e os materiais utilizados evoluíram, atingindo reconhecimento como método adjuvante no tratamento não cirúrgico de lesões pós traumáticas hemorrágicas. A angiografia por subtração digital permite a identificação e a pronta avaliação dos sítios de hemorragia, sendo por muitas vezes mais sensível que outros métodos de imagem, além deste fato, podendo oferecer o recurso terapêutico no mesmo ato do exame diagnóstico(2). Objetivo: Nosso estudo visa avaliação da eficácia e segurança relacionadas ao manejo transarterial - não cirúrgico - dos pacientes vítima de trauma, com análise dos resultados técnicos e clínicos do tratamento endovascular destes pacientes com diferentes agentes embolizantes. Materiais e métodos: Estudo de coorte retrospectiva que incluiu pacientes vítimas de traumatismo abdominopélvico fechado ou perfurante, com sangramento ativo, evidenciado por método de imagem, submetidos a embolização transarterial percutânea, na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, entre janeiro de 2009 e janeiro de 2018. Todos os pacientes incluídos no estudo foram avaliados em conjunto pelas equipes de cirurgia e de radiologista intervencionista de plantão, que analisaram a indicação de angiografia arterial para pesquisa de sangramento e embolização transarterial baseada em protocolo pré-estabelecido na rotina do atendimento do paciente politraumatizado admitidos na Instituição. Resultados: Os achados encontrados foram consistentes com a literatura atual demonstrando altas taxas de sucesso técnico e clínica associado a baixas taxas de complicações inerentes ao procedimento transarterial percutâneo. Conclusão: O presente estudo demonstrou a segurança do procedimento com elevada taxa de sucesso clínico e angiográfico, associado com baixos índices de complicações relacionadas ao procedimento. / Introduction: Interventional radiology uses minimally invasive endovascular techniques to staunch hemorrhages in trauma-related clinical settings. The purpose of these techniques is to contain bleeding quickly and effectively, without the physiological stress determined by open surgery. In this context, this therapeutic modality was first described in 1977 (1), in the treatment of closed abdominal trauma with bleeding due to hepatic injury. Since then the endovascular techniques and the materials used have evolved, reaching recognition as an adjuvant method in the nonsurgical treatment of bleeding post traumatic lesions. Digital subtraction angiography allows the identification and prompt evaluation of hemorrhage sites, being often more sensitive than other imaging methods, besides being able to offer the therapeutic resource at the same time as the diagnostic examination (2).Objective: Our aim is to evaluate the efficacy and safety of the non-surgical transarterial management of the victims of trauma and to verify the repercussion in the technical and clinical results of the endovascular treatment of these patients with different embolizing agents. Materials and methods: A retrospective cohort study that included patients with traumatic or blunt trauma, with active bleeding, evidenced by imaging method, submitted to endovascular embolization, at the Hospital das Clínicas Emergency Unit - FMRP-USP, from January 2009. All the patients included in the study were evaluated jointly by the interventional and interventional radiology team on call at the institution, together the teams analyzed the indication of arterial angiography for bleeding and endovascular embolization based on a pre-established protocol in the routine of care of the polytraumatized patient admitted to the Emergency Unit (HCFMRP-USP). Results: The findings were consistent with current literature demonstrating high rates of technical and clinical success associated with low rates of complications inherent to the percutaneous transarterial procedure. Conclusion: The present study demonstrated the safety of the procedure as well as its high clinical and angiographic success rate, associated with a low rate of complications related to the procedure.

Ce travail de recherche a pour objectif d’expliquer comment des enfants d’âges différents acquièrent des phénomènes linguistiques supposés complexes en roumain langue maternelle. Dans cette recherche nous avons retenu les phénomènes complexes suivants :- les verbes complexes ;- les relatives explicatives et déterminatives ;- les prédications complexes à deux compléments locatifs et deux temporels ;- les prédications complexes par réduction de deux prédications simples et- les prédications à trois verbes opérateurs.Pour décrire le parcours acquisitionnel des enfants, nous avons décrit les procédures de reformulation que des enfants de 6, 8, et 10 ans mettent en place lorsqu’ils restituent une histoire venant de leur être lue. Après l’analyse des procédures de reformulation pour chaque tranche d’âge nous sommes arrivées aux conclusions suivantes :A 6 ans :- les enfants ont tendance à effacer ou à simplifier les verbes complexes. Ces verbes complexes sont remplacés par des verbes lexicalement plus simples et plus fréquents.- les enfants restituent souvent les énoncés sources par des reformulations partielles et lacunaires.- ils ont tendance à reformuler la suite principale-relative en ne gardant que la principale. A cet âge les enfants utilisent un lexique simple, plus courant ou moins contraint.A 8 ans :- les enfants diversifient de plus en plus leurs procédures de reformulation : répétition, paraphrase sémantique, fonctionnelle et restructuration. Toutefois, la procédure de reformulation majoritaire est la paraphrase définitoire analytique lacunaire ce qui confirme le fait que les verbes complexes constituent un phénomène linguistique complexe.- les enfants reformulent les relatives explicatives en un nombre nettement supérieur par rapport aux enfants de 6 ans. Ils diversifient beaucoup plus les procédures de reformulation paraphrastique. Certaines reformulations maintiennent le degré de complexité de l’énoncé source (synthétisation de deux informations en un mot). Toutefois, les enfants à cet âge ont encore des difficultés à reformuler une relative déterminative contenant une métaphore ou à reformuler une prédication complexe composée de deux prédications élémentaires.A 10 ans :- les enfants reformulent sans difficulté les énoncés qui contiennent des relatives explicatives. Ils produisent un nombre supérieur de reformulations par paraphrase sémantique par rapport aux plus jeunes. C’est à cet âge également qu’ils complexifient de plus en plus les énoncés sources, cas de reformulation définitoire analytique complète et restructurations des deux prédications en sont un exemple.A cet âge, les enfants n’ont pas encore acquis les énoncés qui ont un haut degré de complexité syntaxique et sémantique comme la relative déterminative avec une métaphore, ce qui confirme l’hypothèse de la complexité de ce phénomène. / The aim of this research is to explain how children of different ages acquire linguistic phenomena which are supposed to be complex in Romanian as a mother-tongue language. In this research, we selected the following complex phenomena:- Complex verbs;- Non-restrictive and restrictive relative clauses;- Complex predication with two locative and two temporal complements.- Complex predication by reduction of two simple predications and- Predication with three operator verbsTo describe the learning path of children, we described the reformulation procedures that children aged 6, 8 and 10 follow when they reproduce a story that has just been read to them. After analyzing the reformulation procedures for each age group, we came to the following conclusions:At 6 years:- children tend to erase or simplify complex verbs. These complex verbs are replaced by lexically simpler and more frequent verbs.- they often reproduce source phrases by partial and incomplete reformulations.- they tend to reformulate relative clauses by simple phrases with a single predicate or erase information of complex phrases (non-restrictive and restrictive relatives). At this age, children use simple, more frequent or less restrained vocabulary.At 8 years:- children increasingly diversify their reformulation procedures: repetition, semantic and functional paraphrasing and restructuring. However, the reformulation procedure which is widely used is the incomplete analytical definitional paraphrase which confirms the fact that complex verbs constitute a complex phenomenon.- At this age, the number of reformulated non-restrictive clauses is significantly high as compared to that of children at the age of 6 year. They diversify much more paraphrastic reformulation procedures. Some reformulations maintain the same degree of complexity as the source phrases (synthesizing information). However, children at this age still have difficulties reformulating restrictive relative clauses that contains a metaphor or reformulating a complex predication composed of two elementary predications.At 10 years:- children reformulate non-restrictive phrases without any difficulties. They produce a high number of reformulations by semantic paraphrasing as compared to younger children. It is also at this age that they increasingly complexify the source phrase (the case of complete analytical definitional reformulation and restructuring of the two predications are good examples).- At this age, children have not yet acquired phrases with high degree of syntactic and semantic complexity such as the restrictive relative clauses with a metaphor, which confirms the hypothesis that this phenomenon is complex.

Student Number : 9000040F - M Dentistry research report - Faculty of Health Sciences / This study assessed the sagittal soft-tissue changes of the lower lip and chin area in 22 patients subsequent to mandibular autorotation following surgical vertical impaction of the maxilla. A subgroup of six patients in addition had undergone advancement genioplasty procedures. Lateral cephalometric radiographs were taken immediately prior to surgery and on average 15 months following surgery. Sixteen cephalometric landmarks were identified on each radiograph and these were digitized using a Kontron Videoplan Image Analysis System to enable differences reflecting changes to be assessed. The comparison between those cases that had had maxillary elevation only and the six cases that had received additional advancement genioplasty procedures revealed statistically significant differences in relation to the proportional changes in the chin area. Therefore, when studying the soft-tissue chin changes following mandibular autorotation, these six patients were excluded from the sample. It was found that there was no significant difference in the lower lip response between the two groups and therefore when studying the lower lip changes, the two groups could be pooled. The soft-tissue changes in the chin area showed statistically and clinically significant correlations. In the horizontal plane, a ratio of 0.9:1 was found for the changes between sulcus inferior and point B, between soft-tissue pogonion and hard-tissue pogonion, and between soft-tissue gnathion and hard-tissue gnathion. In the vertical dimension, soft-tissue gnathion followed hard-tissue gnathion in a ratio of 0.9:1, whereas soft-tissue menton followed hardtissue menton in a ratio of 1:1. In the study of the lower lip response, a significant correlation with a ratio of 1:1 existed for the horizontal change in the lower lip as measured at labrale inferius relative to both lower incisor tip and lower incisor anterius. In the vertical dimension, stomion inferius followed lower incisor anterius in a ratio of 1.3:1, while labrale inferius followed lower incisor anterius in a ratio of 1.5:1. Multiple regression analyses revealed that presurgical tissue thickness exerted no influence upon the strength of the correlations between changes expressed at corresponding soft- and hard-tissue landmarks located in the lower lip and soft-tissue chin area. Based on the findings of this study, it is suggested that the soft-tissue to hard-tissue ratios may be applied to prediction tracings with enhanced confidence. As a result, the tracings will reflect a more accurate prediction of the lower lip and soft-tissue chin positions following autorotation of the mandible.

Orientador: Silvia Cristina Mangini Bocchi / Banca: Magda Cristina Querioz Dell"Acqua / Banca: Janete Pessuto Simonetti / Banca: Sueli Moreira Pirolo / Banca: Antônio Carlos Siqueira Junior / Resumo: Trata-se de pesquisa na abordagem qualitativa realizada na cidade de Londrina, Paraná, Brasil, e teve como objetivos compreender a experiência interacional homem-processo saúde-doença de usuários de serviços de urgência e emergência atendidos com crise hipertensiva e propor um modelo teórico representativo dessa experiência. A saturação teórica se configurou mediante a análise da vigésima primeira entrevista do tipo não diretiva, tendo como pergunta de partida: "Conte-me sobre a sua experiência em relação aos cuidados com a sua saúde.". As entrevistas foram audiogravadas, transcritas na íntegra e analisadas segundo os passos da Teoria Fundamentada nos Dados, de junho de 2011 a junho de 2012. Da análise das experiências emergiram três subprocessos: concebendo o cuidado à saúde inerente ao feminino: uma fantasia do masculino; aprisionando-se ao papel de homem com superpoderes sobre sua saúde; vivenciando a materialidade da doença nas comorbidades. Do realinhamento dos componentes desses subprocessos originou a categoria central e modelo teórico, denominado "movendo-se entre o fortalecimento e a fragilização do poder como homem de saúde inabalável: o medo do diagnóstico médico imaginado como componente interveniente para a materialidade da doença.". Analisando-o à luz do interacionismo Simbólico, verificou-se a necessidade de o indivíduo reconfigurar o seu self, dando a si mesmo a oportunidade de romper com a concepção de homem com superpoderes sobre a sua saúde para poder (re)alinhar-se a comportamentos saudáveis e abandonar o autocontrole de sua saúde sem auxílio de serviços de saúde. A pesquisa corrobora resultados de estudos anteriores, porém o modelo teórico descoberto configura-se em grande contribuição se considerado protótipo tecnológico para profissionais da saúde ajudarem homens a refletirem e se auto-avaliarem, ao interagirem com ele durante ações educativas / Abstract: This is a qualitative study conducted in the city of Londrina, Paraná, Brazil, and it aimed at understanding the interactional experience man-health-disease process of users of urgency and emergency services attended to when facing a hypertensive crisis and at proposing a theoretical model of such experience. Theoretical saturation was configured by analyzing the twenty one non-directive interview with the starting request: "Tell me about your experience in relation to your health care". The interviews were audiotaped, fully transcribed and analyzed according to the steps of the Grounded Theory from June 2011 to June 2012.Three sub-processes emerged from the analysis of the experiences: conceiving health care as inherent to females: a male‟s fantasy; being trapped to the role of a man with superpowers over his health; experiencing the materiality of disease comorbidities. The realignment of these sub-components gave origin to the theoretical model and the core category denominated "moving between the strengthening and weakening of power as a man of unfailing health: the fear of medical diagnosis imagined as intervenient component for materiality of disease". When examined in light of Symbolic Interactionism, there was the need for the individual to reconfigure his self, giving himself the opportunity to break with the conception of a man with superpowers over his health in order to (re)align with healthy behaviors and abandon the self-control of his disease without help from health care services. The study confirms results from previous investigations, but the theoretical model discovered is configured as great contribution if considered as a technological prototype for health professionals to help men reflect and evaluate themselves when interacting with them during educational activities / Doutor

Este trabalho enfoca a cidade de Porto Alegre no período de 1937 a 1961,reconstruindo no tempo a produção das idéias e práticas do urbanismo desenvolvidos no âmbito das administrações municipais da cidade. O ponto central é a produção do conjunto de dispositivos legais que vão sendo produzidos como instrumentos de ordenação e controle da produção do espaço urbano, público e privado. Mostra-se como esses instrumentos vão sendo idealizados relacionados às idéias difundidas nos meios técnicos e políticos locais a cada tempo. Procura-se identificar a origem dessas idéias sobre a cidade e o urbanismo a partir do discurso e das práticas adotadas pelos especialistas e pelos dirigentes a cada período. Privilegia-se a avaliação daqueles instrumentos que vão determinar o controle da altura das edificações e, portanto vão influir no processo de verticalização da cidade. As avaliações são procedidas dentro de um campo contextualizado, identificando-se a cidade especialmente, no âmbito políticoadministrativo, meio no qual vai sendo produzido o instrumental jurídico analisado. / This work investigates the city of Porto Alegre in the period from 1937 to 1961,rebuilding in the time the production of the ideas and practices of the urbanization development in the extent municipal administrations of the city. The central focus is the production of the group of legal devices that were edited as instruments of public policies of ordination and control of the urban space. The analysis is driven through the evaluation of those instruments on the political and administrative context. It show, at the same time, as those regulations were being formulated relating to city concept and its current urbanization process proposed by the technical body and local political forces, considering to identify their origins and diffusing forms. The main concern are the instruments that established control devices about the height of construction and its influence and relation to the production of the building typologies that characterized the verticalization process of the city in each period of analysis.

INTRODUÇÃO: A tuberculose urogenital é rara, tem diagnóstico tardio e é potencialmente destrutiva ao trato urogenital masculino. A bexiga contraída ocorre nas fases tardias de sua evolução e está associada à alta freqüência de exclusão renal unilateral, refluxo vésico-ureteral, estenose ureteral e insuficiência renal. A ampliação vesical é o tratamento padrão para estes casos. O presente trabalho avalia o seguimento tardio de 25 pacientes com bexiga contraída por tuberculose submetidos à ampliação vesical. CASUÍSTICA E MÉTODOS: Vinte homens e cinco mulheres, com idade mediana de 40 (12 a 60) anos foram estudados. Antes da ampliação, três pacientes estavam em insuficiência renal crônica em programação para transplante renal. Os demais pacientes possuíam exclusão renal funcional unilateral. Em oito casos, a ampliação foi feita com segmento ileocecal não destubulizado, em quatro com sigmóide não destubulizado e em 13 com sigmóide destubulizado. Os pacientes foram submetidos à avaliação clínica, radiológica e urodinâmica pós-operatória. Foi considerado bom resultado, após a ampliação, a presença de intervalo miccional diurno maior que duas horas e a satisfação do paciente avaliada pela pergunta sobre qualidade de vida do questionário \"ICSmaleSF\". RESULTADOS: O seguimento pós-operatório médio foi de 11,1 ± 9,1 (1 a 36) anos com 68% dos pacientes com seguimento maior que cinco anos e 52% maior que 10 anos. Um paciente morreu por um adenocarcinoma na bexiga ampliada após 25 anos de ampliação e seis anos de transplante renal. Após a ampliação, houve manutenção da mesma função renal em todos os pacientes, com exceção de dois casos de evolução para insuficiência renal crônica. Em sete (28%) casos, houve alto resíduo pós miccional com resolução após desobstrução cirúrgica em três casos e autocateterismo nos demais. Bom resultado foi encontrado em 80% dos pacientes operados. O mau resultado foi associado estatisticamente com a utilização do sigmóide não destubulizado (p <= 0,05) e tendeu a se associar com a presença de prostatite por tuberculose (p = 0,09). A comparação dos pacientes de mau com os de bom resultado mostrou que estes apresentaram, ao exame urodinâmico, bexiga ampliada com maior capacidade (p < 0,01), maior complacência (p < 0,01) e sensibilidade normal (p = 0,03). Entretanto, não houve diferença na presença de contrações involuntárias (p = 0,27) entre os dois grupos. Nos pacientes com bom resultado, as contrações iniciaram-se com maior volume de enchimento vesical (p = 0,02). CONCLUSÕES: No seguimento tardio da ampliação da bexiga contraída por tuberculose, 80% dos pacientes atingem intervalo miccional maior que duas horas e a ampliação vesical não contribui para a piora da função renal. O cólon sigmóide deve ser destubulizado, mas o segmento ileocecal pode ser utilizado na sua forma original sem destubulização para a ampliação vesical. O bom resultado com intervalo miccional maior que duas horas necessita de bexiga ampliada com capacidade maior que 250 ml, complacência maior que 20 ml/cm H2O e sensibilidade normal, sem influência da presença de contrações involuntárias. / INTRODUCTION: Urogenital tuberculosis is a rare disease with delayed diagnosis and is potentially destructive for the male urogenital tract. Chronic tuberculous cystitis is a late event in the tuberculosis evolution and is associated with high frequency of unilateral nonfunctioning kidney, ureteral reflux or stenosis and renal failure. Bladder augmentation is the standard treatment in these cases. The present study analyzes the late results of 25 patients with chronic tuberculous cystitis submitted to bladder augmentation. PATIENTS AND METHODS: Twenty men and five women, with median age of 40 (12 to 60) years were evaluated. Prior to augmentation, three patients had chronic renal failure and were in kidney transplantation program. The remaining patients had unilateral nonfunctioning kidney. In eight cases the augmentation was performed with tubularized ileocecal segment, in four with tubularized sigmoid and in 13 with detubularized sigmoid. All patients were submitted to postoperative clinical, radiological and urodynamic evaluation. It was considered a good result the miccional diurnal frequency of more than two hours and the patient?s satisfaction evaluated by the quality of life question from the ICSmaleSF questionnaire. RESULTS: The median follow-up time was 11,1 ± 9,1 (1 a 36) years. In 68% of the patients this time was higher than five years and in 52% higher than ten years. One patient died due to an adenocarcinoma in the augmented bladder 25 years after bladder augmentation and six years after kidney transplantation. After augmentation, all but two patients had the renal function preserved. In seven (28%) cases there was high post-void residue treated by surgery for bladder outlet obstruction in three cases and by intermittent self-catheterisation in the others. Good results were achieved in 80% of the patients. Bad results were statistically associated to augmentation performed with tubularized sigmoid (p <= 0,05) and in patients with prostatitis as a tendency (p = 0,09). The good result patients showed augmented bladder with higher capacity (p < 0,01), higher compliance (p < 0,01) and normal bladder sensation (p = 0,03) in comparison to the bad result patients. However, there was no difference in the frequency of involuntary contractions (p = 0,27) between these two groups. In good result patients the contractions started with higher bladder filling volume (p = 0,02). CONCLUSIONS: At late follow-up of bladder augmentation 80% of the patients with chronic tuberculous cystitis achieve miccional diurnal frequency of more than two hours and the augmented bladder does not contribute to the worsening of the renal function. The sigmoid has to be always detubularized but the ileocecal segment can be used in the tubularized form to augment the bladder. Augmented bladder with capacity of more than 250 ml, compliance of more than 20 ml/cm H2O and normal sensation is necessary to achieve miccional diurnal frequency of more than two hours and there is no interference of the presence of involuntary contractions.

Neste trabalho foram estudados os efeitos da radiação ionizante (gama) em mangas para exportação, simulando a etapa de acondicionamento da fruta durante o seu transporte, através da refrigeração em câmara fria. Em uma primeira etapa foram analisadas perda de peso, pH, acidez titulável, teor de sólidos solúveis, textura e decomposição. Posteriormente, realizaram-se análises sensoriais (alterações de cor, odor, sabor, textura). Os ensaios foram realizados em dois estádios de maturação das frutas, ou seja, 2 e 3, com o propósito de se estudar o melhor ponto de colheita para a melhor dosagem de irradiação. Os resultados revelam que o tratamento da manga Tommy Atkins na dose de 0,75 kGy foi significativo, juntamente com a fruta no estádio 2, para o retardo do amadurecimento e consequente ganho de tempo para a exportação. / It had been studied the effect of the ionizing radiation (gamma) in mangoes for exportation, simulating the stage of preservation of the fruit during its transport, through the refrigeration in cold chamber. In a first stage they had been analyzed through loss of weight, pH, treatable acidity, soluble solid, texture and decomposition. Later, sensorial analyses had been become fulfilled (alterations of color, odor, flavor, texture). The assays had been carried through in two stadiums of maturation of the fruits, that is, 2 and 3, with the intention of studying optimum point of harvest for the best dosage of irradiation. The results disclose together that the treatment of the mangoes Tommy Atkins in the dose of 0,75 kGy was significant, with the fruit in stadium 2, for the retardation of the matureness and consequent profit of time for the exportation.

Talassemias são as mais comuns desordens monogenéticas em humanos; são caracterizadas pela presença de anemia microcíticas e hipocrômicas que resultam da redução ou ausência na síntese de uma ou mais cadeias globínicas. No Brasil a beta-talassemia tem importante significado clínico e sua ocorrência pode ser explicada como conseqüência da grande mistura étnica. A beta-talassemia é extremamente heterogênea e mais de 200 mutações têm sido descritas causando diferentes graus de anemia. Essas mutações são regionalmente específicas e cada país possui seu grupo de alterações característico. No estado homozigoto são classificadas clinicamente como major e no estado heterozigoto como intermédia e minor. Os pacientes com talassemia intermédia podem não apresentar sintomas clínicos, mas constatam-se características laboratoriais específicas. A avaliação dos índices hematológicos, dosagens dos parâmetros bioquímicos e dos valores das hemoglobinas fetal e HbA2 em combinação com o entendimento das possíveis interações gênicas são os procedimentos recomendados para o diagnóstico laboratorial. O objetivo deste estudo foi determinar a presença de mutações em pacientes que utilizam a Divisão de Laboratório Central do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo (DLC-HC-FMUSP) e que apresentavam perfil laboratorial sugestivo para beta-talassemia. Estudou-se a região do gene da globina em onde estão descritas as mutações mais freqüentes para nosso meio através da técnica de PCR, e posterior seqüenciamento para identificação das mutações. As mutações observadas na população avaliada (N=40), em ordem crescente de freqüência foram: Codon 39 (CT), IVS-I-110 (GA), IVS-I-1(GA), IVS-I-5 (GC), IVS-I-6 (TC), IVS-I-Exon-II (GA), Exon-II-IVS-II (GA), Stop Cd 6 (GT), Stop Cd15 (GA), Del C Cd 44 e 5UTR+20. Os primeiros quatro genótipos representaram 82,5% das mutações observadas neste trabalho. O uso combinado dos índices hematimétricos, parâmetros bioquímicos e avaliação das características morfológicas das hemácias demonstraram eficiência no rastreamento de pacientes portadores de beta-talassemia, assintomáticos A técnica do PCR e posterior processo de seqüenciamento demonstraram elevada eficiência na determinação das alterações moleculares no grupo de pacientes avaliados. / Thalassemias are the most common monogenic disorders in humans; are characterized by hypochromic and microcytic anemia arising from the reduction or absence in the synthesis of one or more chains globínicas. In Brazil, beta-thalassemia has important clinical significance and its occurrence can be explained as a result of the large ethnic mix. The beta-thalassemia is extremely heterogeneous and more than 200 mutations have been described causing varying degrees of anemia, these mutations are regionally specific and each country has its characteristic group of amendments. In the homozygous state are clinically classified as major and the heterozygous state as intermediate and minor. Patients with thalassemia can not present interim clinical symptoms, but have characteristics specific laboratory. The evaluation of hematologic indices, strengths and biochemical parameters of fetal hemoglobin and HbA2 values in combination with an understanding of possible interactions genes, are the recommended procedures for laboratory diagnosis. The purpose of this study was to determine the presence of mutations in patients who use the Division of Central Laboratory of the Hospital of the Faculty of Medicine of the University Sao Paulo (DLC-HCFMUSP) who presented suggestive profile laboratory for beta-thalassemia. It was studied the region of the gene of beta globin where they are frequently described the changes to our region through the PCR technique, and subsequent sequencing to identify the mutations. Of the 40 patients evaluated were found the following changes: Codon 39 (CT), IVS-I-110 (GA), IVS-I-1 (GA), IVS-I-5 (GC), IVS-I-6 (TC), IVS-I-Exon-II (GA), Exon-II-IVS-II (GA), Stop Cd 6 (GT), Stop Cd15 (G A), Del Cd 44 and 5UTR+20. The first four genotypes accounted for 82.5% of mutations observed in this study. The combined use of hematologic indices, biochemical parameters and evaluation of morphological characteristics of red blood cells demonstrated efficiency in the tracking of patients with beta- thalassemia, asymptomatic. The technique of PCR and subsequent process of sequencing demonstrated high efficiency in determining the molecular changes in the group of patients evaluated.