Airton Camacho Moscardini

Health and quality of life of medical residents

OBJECTIVE This article highlights the relationship between health and quality of life among the resident medical staff. METHODS A review was carried out to analyze the content of the relationship under study. Sources for this search were the Virtual Health Library (VHL), by BIREME (Centro Latino-American and Caribbean Center on Health Sciences Information), the Electronic databases Medline (Medical Literature Analysis and Retrieval System On-Line) Lilacs (Literatura Latino-American and Caribbean Health Sciences), SciELO (Scientific Electronic Library Online) and the email address scholar.google.com.br. Descriptors used were: Quality of life, Burnout, Internship and Residency. Planning and analysis of scientific literature, was performed to evaluate and discuss issues presented in the studies related to the subject, considering the distribution of publications according to country of origin, date of publication, source and title, focus of study and main conclusions. RESULTS Studies published point to high rates of burnout, stress, depression, fatigue and insomnia among medical residents; moreover a lack of coping strategies, the relationship between workload and quality of life, require a change of medical legislation regarding work-based learning. CONCLUSION Studies have shown that an adequate training program is needed not only to increase professional qualification and personal quality of life, but also to provide safety during patient treatment. It is known that residency training is stressful; it is nevertheless a process required to prepare for a solid career and personal growth of the young medical staff.OBJETIVO: Discutir sobre saude e qualidade de vida de medicos residentes. METODOS: Estudo de revisao bibliografica no qual se realizou a analise de conteudo do assunto enfocado. A fonte de busca foi a Biblioteca Virtual em Saude (BVS), por meio da BIREME (Centro Latino-Americano e do Caribe de Informacao em Ciencias da Saude), nas Bases Eletronicas Medline (Medical Literature Analysis and Retrietal System On-Line), Lilacs (Literatura Latino-Americana e do Caribe em Ciencias da Saude), SciELO (Scientific Eletronic Library On Line) e pelo endereco eletronico scholar.google.com.br. Os descritores utilizados foram: qualidade de vida, estresse, internato e residencia. Realizou-se o ordenamento e a analise da bibliografia cientifica, de modo a avaliar e discutir aspectos apresentados nos estudos com relacao a tematica, considerando a distribuicao das publicacoes segundo pais de origem, o periodo de publicacao, a fonte e o titulo, o foco de estudo e as principais conclusoes. RESULTADOS: As publicacoes analisadas abordam aspectos importantes como incidencias elevadas de Burnout, estresse, depressao, fadiga e sono entre os residentes; dificuldade de enfrentamento; relacao entre carga horaria de trabalho e qualidade de vida; necessidade de melhorias na legislacao da residencia medica para melhorar as condicoes de trabalho e aprendizado. CONCLUSAO: A implementacao de programas de assistencia aos residentes produz melhorias na qualidade da capacitacao profissional e na qualidade de vida pessoal, melhorando o relacionamento com os pacientes. Apesar de estressante, a residencia medica e uma experiencia enriquecedora, que propicia o desenvolvimento profissional e pessoal dos jovens medicos.

Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass

OBJECTIVE: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques. METHOD: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with seven patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups. RESULTS: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied. CONCLUSION: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

Mixoma Atrial Esquerdo com Acidente Vascular Cerebral Isquêmico em Criança

The authors present a case of left atrial myxoma with stroke in an 8-year-old female child. The tumor was removed and two months after the surgery a left atrial septum mass was observed suggesting recurrence. The child was asymptomatic. Literature review emphasizes the rarity and clinically aggressive behavior of this tumor at this age group and demonstrates rare recurrence rates after surgery.

A Trileaflet “Mitral Valve” with Three Papillary Muscles: Brand New Echocardiographic Finding

Congenital mitral valve malformations are rare, but are well known and described entities. Mitral valve malformations involve mitral valve apparatuses (leaflets and annulus) and subvalvar apparatuses (chordae and papillary muscle). Case reports of accessory mitral leaflets were already described, but were usually an appendix of the normal valve. We describe here a case report and present the images of a trileaflet mitral valve sustained by three papillary muscles in a young girl with subaortic stenosis.

Oxigenação extracorpórea por membrana e alterações hematológicas em estudo experimental

Extra-corporeal membrane oxygenation is a technique of prolonged cardiopulmonary support, with the objective of assisting the lungs and/or heart when they start to fail and do not respond to conventional non-invasive treatment. The aim of this study was to evaluate hematological alterations during 12 hours of extra-corporeal membrane oxygenation in animals. Eleven sheep, six males and five females, of the Santa Ines breed with weights ranging from 5.4 to 15kg (12.2±3.1kg) were studied. With the first five animals, Ringer solution with sodium lactate (Ringer - Lactato Glicolabor - Ribeirao Preto - SP) and a 3.5% gelatine solution (Hisocel - Campinas -SP) were used to prime the extra-corporeal circuit in the proportion of 2:1 making a total of 750ml. In the sixth animal the volume of the circuit primer was reduced to 450ml, composed of 250ml of Ringer solution with sodium lactate and 200ml of 3.5% gelatine solution. In the other 5 animals 250ml of total fresh blood anticoagulated with sodium citrate and 200ml of Ringer solution with sodium lactate were employed. The blood tests performed were: hematocrit, haemoglobin, leukocytes, platelets, albumin and globulin. Mann-Whitney and variation analysis tests were used for statistical evaluation and, in the case that the variation analysis gave a significant difference (p < 0.05), the Tukey test was applied. A reduction of all the elements analysed was observed with a significant statistical difference in the values of hematocrit and leukocytes between the two groups. The hematological alterations seen in this study were exclusively due to the excessive supply of fluid volumes.

A Trileaflet "Mitral valve" with three papillary muscles

Congenital mitral valve malformations are rare, but are well known and described entities. Mitral valve malformations involve mitral valve apparatuses (leaflets and annulus) and subvalvar apparatuses (chordae and papillary muscle). Case reports of accessory mitral leaflets were already described, but were usually an appendix of the normal valve. We describe here a case report and present the images of a trileaflet mitral valve sustained by three papillary muscles in a young girl with subaortic stenosis.

Solitary fibrous tumor in a child's heart

1. Servico de Cirurgia Cardiovascular Pediatrica de Sao Jose do RioPreto – Hospital de Base – Faculdade de Medicina de Sao Jose doRio Preto, SP, Brasil.Endereco para correspondencia: Ulisses Alexandre CrotiHospital de Base – FAMERP – Avenida Brigadeiro Faria Lima, 5544.CEP 15090-000 – Sao Jose do Rio Preto – SP - BrasilFone (Fax): 55 - 17 - 3201 5025 / 3222 6450 / 9772 6560E-mail: uacroti@uol.com.br

Caso 5/2005 - Cavopulmonar total extracardíaco com tubo de pericárdio bovino corrugado sem auxílio de circulacão extracorpórea

CLINICAL DATAA full-term male patient weighing 3.2 kg at birth returned tothe hospital at three months of age suffering from fatiguewhile breast-feeding, episodes of dyspnea and wasdiagnosed with a complex heart disease with pulmonaryhyperflow. The patient was submitted to bandaging of thepulmonary trunk in the Heart Institute of the Hospital dasClinicas, University of Sao Paulo Medical School (INCOR –HCFMUSP). At five years of age, with 18 kg, afterabandoning medical care, the infant returned to our servicewith moderate cyanosis and a complaint of fatigue duringmoderate exercise. The heartbeat was rhythmic with anormophonetic sound and 3+/6 systolic murmur at the medialleft and high right sternal borders. Pulmonary auscultationwas normal and the abdomen showed no changes. Thearterial pressure and peripheral pulses displayed no realdifferences and the peripheral saturation was 74%.ELECTROCARDIOGRAMThe electrocardiogram showed sinus rhythm with a heartrate of 80 bpm. The SÂP was +60 with an overload of theright atrium (RA), a spiked P wave of 3 mm at D2 and AVFand a PR interval of 0.20 seconds. The QRS complex axiswas + 30o. Additionally, a delayed voltage transition of theQRS complex on the horizontal axis characterized by a slow

Avaliação tomográfica pulmonar tardia em prematuros com displasia broncopulmonar e persistência de canal arterial

OBJECTIVE: To assess through high-resolution computed tomography the pulmonary parenchyma of children prematurely born with both very low birth weight and patent ductus arteriosus submitted to medical or surgical treatment that developed bronchopulmonary dysplasia. METHODS: Between December 2006 and January 2007, 14 children prematurely born with a weight less than 1500g with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) were submitted to high-resolution computed tomography (HRCT). All of them underwent surgical closure of the canal divided into two groups: A - medical (n=6) and B - surgical (n=8). The pool of patients comprised 9 baby boys and 5 girls who were 36.5±4.3 month-old. The HRCT were analyzed by two independent observers and quantified in each patient. The statistical analyses were assessed using the Mann-Whitney test, and p<0.05 was considered statistically significant. RESULTS: Three patients presented normal tomographies, being two of A group and one of B. In A, the most frequent finding was multifocal ground-glass opacity. In B, multifocal ground-glass opacity, atelectasis, and low attenuation areas with relatively decreased number and caliber of vessels were prevalent (62.5%). There was a statistically significant difference between both groups, with B having higher averages in the intubation times, use of oxygen, and admission. However, as to the number of injuries found on HRCT there was no statistically significant difference (p=0.0787). CONCLUSION: The lately use of HRCT have shown no significant difference between both medical and surgical treatment aiming at to occlude the PDA in pulmonary parenchyma injuries of premature with PDA that developed bronchopulmonary dysplasia.

Tomografia computadorizada na avaliação tardia do tratamento cirúrgico da conexão anômala total de veias pulmonares

OBJECTIVE To evaluate if the findings of multislice computed tomography (MSCT) are associated with clinical and laboratory tests routinely used in the late follow-up of children undergoing surgical treatment of total anomalous pulmonary venous connection (TAPVC). METHODS From January 2002 to December 2007, 12 patients operated due to CATVP were evaluated with history, physical examination, chest X-ray, electrocardiogram, echocardiography and MSCT. Specific changes observed in each one of these tests were identified and compared with MSCT qualitative findings. RESULTS Eleven patients were in functional class I (NYHA), three had nonspecific murmurs, and three were below the 15th percentile of weight and height. Two had pulmonary field abnormalities and three had a slight increase of the cardiac area in the X-ray examination. In the electrocardiogram, one patient had right ventricular overload and one had junctional rhythm. All echocardiograms were within the normal range, except for one patient with stenosis between the superior vena cava and right atrium. MSCT was completely normal in four patients, three had compression of the pulmonary veins and four had significant caliber reduction, which correlated with the other findings. Thus, MSCT showed a sensitivity of 87.5%, specificity of 0.75%, positive predictive value of 87.5%, negative predictive value of 75% and accuracy of 83.3% to demonstrate anatomic changes compared to changes in the physical examination or other additional tests. CONCLUSION MSTC may provide valuable information and complement the diagnosis of possible anatomical and functional changes in the late follow-up of patients undergoing surgical repair of TAPVC.