José Francisco de Sales Chagas

Nutrition Status and Risk Factors Associated With Length of Hospital Stay for Surgical Patients

OBJECTIVE To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS). METHODS The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi-square test was used to compare proportions, and the Mann-Whitney or Kruskal-Wallis test was used to compare continuous measures. Linear association was verified using Spearmans rank correlation coefficient. Coxs regression model was used to investigate factors associated with LOS. RESULTS Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well-nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7-6.2]) than those who had some degree of malnutrition. Well-nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1-5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0-1.1]). CONCLUSIONS LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.

Comunicação oral de laringectomizados com prótese traqueoesofágica: análise comparativa pré e pós-treino

BACKGROUND: speech and voice training for laryngectomized patients with tracheoesophageal prosthesis. AIM: to compare the quality of oral communication of a group of laryngectomized patients with tracheoesophageal prostheses, pre and post speech and voice training. METHOD: voice and speech samples of 17 laryngectomized patients were analyzed before and after receiving speech and voice training. The voice and speech samples were mixed and presented to speech-language pathologists for assessment. RESULTS: statistically significant (Binomial Test) improvement was observed. CONCLUSION: it can be concluded that the proposed training improved the speech patterns, including melody and singing.

Marginal mandibulectomy in the surgical treatment of tonsil and retromolar trigone tumours

UNLABELLED Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY a contemporary cross-sectional cohort study. RESULTS Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

A mandibulectomia marginal no tratamento dos tumores de loja amigdalina e região retromolar

Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS: Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

Risco nutricional no período pré-operatório

BACKGROUND: Bad nutricional status in preoperative period - mainly associated to weight loss -, may lead to grater number of postoperative complications. AIM: To investigate the nutritional risk indicators in preoperative period, stratified by disease groups treated at the site. METHODS: A total of 512 patients with the following conditions were assessed: acute abdomen, digestive tract diseases, biliary diseases, gynecological diseases, vascular diseases, hernias and traumas. The following data were analyzed: body mass index, recent weight loss, habitual energy intake, lymphocyte count and length of hospital stay. The data were compared among the disease groups. The chi-square test or Fishers exact test when necessary was used to compare proportions. The significance level was set at 5%. RESULTS: Trauma patients followed by those with digestive tract diseases and acute abdomen had significantly lower body mass index (P=0.0222), and the ones with acute abdomen presented recent weight loss at hospital admittance (P=0.0048). A greater percentage of severe and moderate immune depletion was seen in patients with acute abdomen (P<0.0001) and those with vascular diseases had a greater percentage of patients with energy intake below 1000 kcalories (P=0.0311). Trauma patients presented longer hospital stays (P<0.0001). CONCLUSION: Trauma and acute abdomen patients had greater nutritional risk during the preoperative period. Thus, nutritional care strategies should be oriented towards them since the hospital admittance.

Actinomicose laríngea: relato de caso

We report a case of a patient with actinomycosis of the larynx mimicking a neoplasm. A literature review, clinical features, pathology and imaging findings is also presented. This paper reports a rare disease occurring in an atypical location, simulating larynx neoplasm. To our knowledge, there is no report of this disease and locations evaluated with computed tomography.

Microsurgical head and neck reconstruction: retrospective analysis of 30 free flaps

Introduction: Reconstructive head and neck surgery is a challenge for the plastic surgeon and requires a large technical arsenal, in which microsurgery plays an essential role. The objective to retrospectively analyze microsurgical head and neck reconstruction performed at the Pontifical Catholic University of Campinas over a period of 2 years. Methods: The medical charts of patients who underwent microsurgical reconstruction after head and neck surgery between June 2014 and October 2016 were reviewed to determine which flap was used, the length of the vascular pedicle, recipient vessels, microvascular anastomoses, surgical time, length of hospital stay, complications, and success rate. Results: Thirty microsurgical reconstructions were performed using 3 types of flaps: anterolateral thigh (n = 15), antebrachial radial (n = 8), and fibula (n = 7). Recipient vessels: facial artery (70%) and facial vein (50%), as 92.4% of microvascular anastomoses were end-to-end. The average operative time was 10.1 hours. The average length of hospital stay was 10.7 days. Two flaps were lost due to arterial thrombosis, resulting in a success rate of 93.3%. Conclusions: The microsurgical reconstructions were effective for the repair of complex defects as well as to partially restore the shape and function of the affected tissues. Complications were observed in less than 50% of the cases, although these presented with significant morbidity. The success rate was similar to that reported by major centers of reconstructive microsurgery. The learning curve is long, although it tends to improve with staff training and the acquisition of experience over time. ■ ABSTRACT