Introduction:High resolution manometry is the current technology used to the study of esophageal motility and is replacing conventional manometry in important centers for esophageal motility with parameters used on esophageal motility, following the Chicago Classification. This classification unifies high resolution manometry interpretation and classifies esophageal disorders. Objective:This review shows, in a pictorial presentation, the new parameters established by the Chicago Classification, version 3.0, aimed to allow an easy comprehension and interpretation of high resolution manometry. Methods:Esophageal manometries performed by the authors were reviewed to select illustrative tracings representing Chicago Classification parameters. Results:The parameters are: Esophagogastric Morphology, that classifies this junction according to its physiology and anatomy; Integrated Relaxation Pressure, that measures the lower esophageal sphincter relaxation; Distal Contractile Integral, that evaluates the contraction vigor of each wave; and, Distal Latency, that measures the peristalsis velocity from the beginning of the swallow to the epiphrenic ampulla. Conclusion:Clinical applications of these new concepts is still under evaluation.
SUMMARY BACKGROUND: Residency programs, especially in surgery, have been undergoing constant changes. The profile of residents in surgical fields is changing too since residents are now part of the Generation Y (Millenials). This change in profile mandates a re-evaluation to adapt surgical residency programs. Six years ago, we carried out a study evaluating attitudes and experiences during training, and the professional expectations of residents. This study aims to survey surgical residents to evaluate current attitudes, experiences, and expectations. METHODS: We surveyed 50 residents to determine professional satisfaction, residency-program satisfaction, future expectations, financial expectations, and correct attitude towards patients. RESULTS: Our results show that half of the residents are satisfied with the residency program. However, dissatisfaction reaches 40% on surgical volume and 80% on mentorship; 62% of the residents are not confident to perform operations after the residency, the majority believes a specialization is necessary; most residents believe financial compensation will decrease with time, but concerns with reimbursement are low; and most residents are worried about injuring patients, but only two thirds are satisfied working with patients. CONCLUSIONS: Current residents present lower job satisfaction and more criticism of teaching techniques. These changes compared to previous results match the profile of Generation Y, who is more iconoclastic when compared to previous generations.
Objetivo: Relatar um caso da Síndrome de Vogt-Koyanagi-Harada em uma mulher e o tratamento do vitiligo. Detalhamento do caso: Trata-se de um relato de caso, apreciado e aprovado pelo Comitê de Ética em Pesquisa local, aprovado sob o número do CAAE 61783722.3.0000.5505. Paciente feminina, 39 anos, parda, casada, ajudante geral, natural e procedente de São Paulo, com queixa de mancha acrômica em vulva, realizou tratamento com tracolimo com melhora clínica. A paciente realizou o tratamento da síndrome com azatioprina e na região da mancha acrômica vulvar com tacrolimo com repigmentação total. A Síndrome de Vogt – Koyanagi – Harada conhecida como síndrome uveomeningoencefálica é caracterizada por uma panuveíte bilateral crônica, comprometimento neurológico, auditivo e cutâneo. Considerações finais: Considera-se que a doença é de etiologia autoimune celular – mediada que atinge os melanócitos. Considerando-se a diversificação das manifestações clínicas, muitas vezes, seu diagnóstico se torna difícil ou delongo. Diante dessa realidade, é imperativo considerar tratamentos que envolvam efeito imunossupressor, para que a paciente consiga atingir o tratamento em sua totalidade.
Na atualidade a prevalência de neoplasia maligna da cavidade oral, em especial o carcinoma de células escamosas, tem sido mais observada. No Brasil, o câncer de boca representa a quinta neoplasia maligna mais predominante entre os homens e a sétima entre as mulheres. Além dos fatores etiológicos como o tabaco e o álcool, nos últimos anos, o Papilomavírus humano também tem sido associado ao desenvolvimento do câncer de cabeça e pescoço. Portanto, o objetivo desse estudo foi apresentar um relato de caso de diagnóstico de carcinoma de células escamosas pouco diferenciado invasivo com HPV positivo orofaringe, em paciente do sexo feminino. O caso em questão demonstra a necessidade de melhor rastreio do câncer de cavidade oral, principalmente, na população imunodeprimida.
A colpocitologia oncótica cérvico-vaginal é um importante exame de rastreio de câncer do colo do útero que deve ser realizado pelas mulheres com periodicidade, inclusive durante a gravidez. Apesar de não ser seu objetivo principal, o exame é capaz de diagnosticar algumas espécies de parasitas vaginais, mesmo em pacientes assintomáticas. O objetivo desse estudo foi relatar um caso de gestante com parasitose vaginal diagnosticada e tratada no Núcleo de Prevenção de Doenças Ginecológicas da Escola Paulista de Medicina da Universidade Federal de São Paulo. O presente documento relata o caso de uma gestante primigesta que foi encaminhada ao serviço terciário por quadro de sangramento vaginal persistente no primeiro trimestre gestacional e que, durante investigação, teve o diagnóstico de vaginite e o achado raro de ovos de Enterobius vermicularis na citologia oncótica cérvico-vaginal. O sucesso do tratamento não é o principal desafio, mas a prevenção de reinfecção ou autoinfecção. Para isso, hábitos de higiene devem ser incentivados a todos os membros da casa, como: lavar as mãos com frequência, evitar coçar o ânus, realizar higiene diária íntima no sentido ântero-posterior (ou seja, da região genital para a região anal) e não compartilhar toalhas e itens de higiene pessoal.
Background: Medical students' interest in surgery is declining. The identification of factors that influence the choice of specialty may be used to create strategies to increase its attractiveness. This study aims to determine the influence of familial status on medical students' motivation for choosing surgical career.Methods: We prospectively surveyed medical students from the last 2 years of medical school regarding their career choice for residency and familial status. We sent a questionnaire to 149 students regarding: demographic data, the type of program chosen for residence, and the main motivation for their choice. Results:The programs chosen for the area of residence were: general surgery for 16 (11%), other areas for 100 (67%) students [18 (18% of other areas, 12% of the total) internal medicine; 15 (15% of other areas, 10% of the total) gynecology and obstetrics; 13 (13% of other areas, 9% of the total) otorhinolaryngology/ ophthalmology; 13 (13% of other areas, 9% of the total) pediatrics; 10 (10% of other areas, 7% of the total) psychiatry, 4 (4% of other areas, 3% of the total) orthopedics, and 25 (25% of other areas, 17% of the total) others] and 33 (22%) had not made a choice. Demographic data was similar between the groups. Motivation for choosing the program was only based on personal satisfaction. Familial status (family history on medicine and family income) was not different between groups.Conclusions: Familial status did not influence the students' choice of a surgical career. The only important motivation was the personal satisfaction.
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