Cesar Augusto Simões

Liga de dor: uma experiência de ensino extracurricular

Os objetivos deste estudo foram descrever um programa extracurricular de educacao em dor, organizado na forma de Liga, e identificar a opiniao dos alunos sobre esse modelo de ensino. O Estatuto e o Regimento Interno da Liga de Dor foram as fontes e dados para a descricao da sua organizacao e funcionamento. Todos os alunos que frequentaram a Liga de Dor nos anos de 1995 e 1996 foram solicitados a responder um questionario sobre suas experiencias na Liga. A Liga de Dor foi organizada sob o patrocinio do Centro Academico Osvaldo Cruz, da Faculdade de Medicina da USP, e Centro Academico XXXI de Outubro, da Escola de Enfermagem da USP, em 1995. E composta por alunos dessas duas faculdades e profissionais enfermeiros e medicos, de varias especialidades. Todas as atividades sao voluntarias, desenvolvidas em periodo extracurricular e os estudantes dirigem a Liga. Os objetivos da Liga sao: melhorar a qualidade do ensino sobre dor nas escolas medica e de enfermagem, desenvolver pesquisas relativas a epidemiologia, clinica e controle da dor e promover modelo de assistencia multidisciplinar e multiprofissional. A maioria dos alunos expressou ter alcancado seus objetivos, total ou parcialmente; ter aumentado seu conhecimento sobre as sindromes algicas e sobre o manejo do doente com dor; sentir-se gratificado com sua atividade; que o tema dor deveria ser incluido no curriculo de modo mais especifico e que recomendaria a outros colegas a participacao na Liga de Dor. As opinioes dos estudantes mostraram que a Liga de Dor pode ser um modelo util para a introducao do ensino da dor nos cursos de graduacao e enfermagem e de medicina.

Conservative treatment in isolated penetrating cervical esophageal injury: case report

Non-iatrogenic traumatic cervical esophageal perforations are usually hard to manage in the clinical setting, and often require a careful and individualized approach. The low incidence of this particular problem leads to a restricted clinical experience among most centers and justify the lack of a standardized surgical approach. Conservative treatment of esophageal perforation remains a controversial topic, although early and sporadic reports have registered the efficacy of non-operative care, especially following perforation in patients that do not sustain any other kind of injuries, and who are hemodynamically stable and non-septic. We report a case of a patient sustaining a single cervical gunshot wound compromising the cervical esophagus and who was treated exclusively with cervical drainage, enteral support and antibiotics.

Does the Intensity of IGG4 Immunostaining Have a Correlation with the Clinical Presentation of Riedel's Thyroiditis?

Riedels thyroiditis (RT) represents one type of IgG4-related thyroid disease (IgG4RTD) and the diagnosis involves quantitative immunohistochemistry showing dense lymphoplasmacellular inflammatory infiltrate consisting of IgG4-positive plasma cells with storiform fibrosis and obliterative phlebitis. We report a case of RT with progressive enlargement of the anterior neck, severe dysphagia, odynophagia, and dyspnea. The patient underwent surgical decompression of the airway, protection tracheotomy, and gastrostomy for nutritional intake 6 months after first symptoms. Complete resolution occurred after surgical treatment combined with prednisolone. Immunostaining revealed IgG4-positive plasma cells 12/HPF (high-power field) and the IgG4/IgG ratio 25%, values that were disproportionate to the intensity of the patients symptoms. As to this case and the few cases described and analyzed in the literature, our impression is that there is no relation between the intensity of symptoms in RT with the total number of IgG4-positive plasma cells and the IgG4/IgG ratio, but more studies are needed.

A Case of “Late” Postsurgical Hypoparathyroidism

Introduction Postsurgical hypoparathyroidism normally occurs a short time after thyroid surgery in form of two clinical syndromes of different etiology and prognosis. The first is transitory and might spontaneously recover within a few weeks or months. The second is permanent and needs a definitive treatment. Only few cases of hypoparathyroidism clinically evident after many years from surgery have been reported. Case Report A case of hypoparathyroidism clinically evident only three and a half years after surgery is reported. Our findings and review of a few cases reported by medical literature suggest the existence of a third form of postsurgical hypoparathyroidism, characterized by a late beginning.

Substernal goiter and laryngopharyngeal reflux

OBJECTIVE This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. SUBJECTS AND METHODS A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. RESULTS The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. CONCLUSION This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.