Book Of Abstracts Braincoms 2012 Brazilian International Congress Of Medical Students

3. MAIN FINDINGS OF HIGH DIGESTIVE ENDOSCOPY IN PATIENTS WITH
LARYNGOPHARYNGEAL REFLUX: RETROSPECTIVE STUDY OF 133 CASES
EDUARDA RAQUEL PRZYGODA ALVES - FURB; BEATRIZ BRITTES KAMIENSKY - FURB; HADELLE
HABITZREUTER HASSMANN - FURB; JAN ALESSANDRO SOCHER - FURB
Introduction: Laryngopharyngeal reflux (LPR) is considered an extraesophageal
manifestation which may or may not be associated with gastroesophageal reflux
disease (GERD) and there are two suggestions for theories to their causes and
symptoms: theory of direct damage and theory of vagal reflex.
Objective: Raise the main findings of upper endoscopy (EGD) in patients with a
diagnosis of laryngopharyngeal reflux.
Methods: Retrospective analysis of results from EGD and urease test of 133 patients
treated between January 2011 and December 2011 selected with a previous
diagnosis of LPR through video faringolaringoscopia. In suspected cases also
underwent biopsy when necessary. Results: The main findings were gastritis
(77%), distal esophagitis (59%), hypofunction of the cardia (40%) and hiatal hernia
(32%). In 9% of patients were identified Barrett's esophagus and neoplasia in 2.2%
of patients. In two cases was identified fungal esophagitis. Only 12% of patients
have normal EGD. In 30% of patients were identified H. pylori positive.
Conclusion: EGD proved to be an important test in the diagnosis of additional
comorbidities that can follow laryngopharyngeal reflux interfering in the
therapeutic setting.

4. EVALUATION OF THE EFFICACY AND TEMPORAL PATTERN OF DRY NEEDLING IN
THE TREATMENT OF MYOFASCIAL PAIN SYNDROME
JULIANA TAKIGUTI TOMA - UNIFESP; MARCUS YU BIN PAI - FCMSCSP; IRINA RAICHER - HC-FMUSP;
HELENA HIDEKO SEGUCHI KAZIYAMA - HC-FMUSP; RICARDO GALHARDONI - HC-FMUSP; MANOEL
JACOBSEN TEIXEIRA - HC-FMUSP; DANIEL CIAMPI DE ANDRADE - HC-FMUSP
Introduction: Myofascial Pain Syndrome (MPS) is a regional muscle pain disorder
accompanied by trigger points. Trigger point dry needling is one of the most
effective treatments available. It relies on mechanical disruption of trigger points,
also inhibiting nociception. In this study, we evaluated in a prospective, sham-
controlled study the pattern of analgesic efficacy of trigger point dry needling in
Myofascial Pain Syndrome (MPS) patients.
Materials and Methods: We evaluated patients with shoulder pain due to excess of
nociception associated with chronic MPS in asymmetrical or unilateral trapezius
muscle trigger points (VAS more painful side less painful side > 40mm). Patients
were randomly assigned to two treatment arms: Active (A) (n=20) and Sham (S)
(n=21). Group A received actual treatment with trigger point dry needling. Group S
received a sham treatment, with the needle inserted superficially in the skin,
without reaching the muscle underneath it. The duration (sec) and pain (VAS)
elicited during active and sham dry needling were controlled for. Patients were
evaluated one week before needling (D-7), on the day of dry needling (D0) and
seven days after the procedure (D+7). Patients filled out the Brazilian version of the
Douleur Neuropathique 4, Beck Depression Inventory, Brief Pain Inventory (BPI),
McGill Pain Questionnaire-SF (SFMPQ), Hospital Anxiety and Depression Scale and
Global Impression of Change, and also filled out a 14-day pain diary with the first
part of the BPI.
Results: 41 patients were included in the trial. Mean VAS was 69.7±17.1 upon
enrollment. The reduction in pain intensity after treatment was significant for the
active group (VAS before=54±19 vs VAS after= 29±20, p<0.05). Changes were not
significant for the sham group (VAS before=57.1±21.4 vs. VAS after= 48.5±29.5,
p=0.333). The total score of pain intensity in the SFMPQ was significantly improved
in Group A (before=51.5±28.7 vs. after= 30±31.6, p<0.05) but not in the sham
group (before=57.1±32.8 vs. 44.3±26.9; p=0.104). The mean pain interference in
life activities did not differe between groups. The worst pain, and average 24h pain
score of BPI decreased in the active group only. There were no correlations
between more intense pain during needling and immediate or long-term pain relief,
which was maximal on the 7th day after needling.
Conclusions: Dry needling MPS trigger points relieve pain when compared with a
sham procedure of the same duration and pain intensity. The analgesic effect built
up on the following days after stimulation and was higher on the 7th day after the
procedure, which argues for long-lasting local effects that go beyond the mechanical
effect of the procedure. Needling may serve as a complementary therapeutic option
in these patients.

5. BRAZILIAN PORTUGUESE TRANSLATION, CROSS-CULTURAL ADAPTATION AND
VALIDATION OF THE HEART CONTINUITY OF CARE QUESTIONNAIRE
DÉBORA COSTA RACHID LACERDA - UNIVERSIDADE FEDERAL DE JUIZ DE FORA (UFJF); LUCAS MENDES
NASCIMENTO - UNIVERSIDADE FEDERAL DE JUIZ DE FORA (UFJF); CARLA MALAGUTI - UNIVERSIDADE
FEDERAL DE JUIZ DE FORA (UFJF)
Introduction: To measure the continuity of care of such patients, a questionnaire
was developed to reflect the patients perspective in several respects. For this
purpose, Hadjistavropoulos et al. developed the "Heart Continuity of Care
Questionnaire" (HCCQ), a specific questionnaire originally written in English
containing 33 questions. It addresses information about the patient's condition,
medication, precautions related to diet and exercise, plans to release the patient
from the hospital and follow-up care. There are also questions about the evaluation
of communication and coordination of the health professionals. The translation and
adaptation of this questionnaire into Portuguese, as well as its validation will allow
it to be used in scientific and clinical fields in Brazil. As the Brazilian Ministry of
Health emphasizes, cardiovascular diseases are the leading cause of death in the
country, which increases the relevance of this study.
Materials and Methods: The sample is composed of patients with clinical and
laboratory diagnosis of cardiovascular diseases, such as hypertension and chronic
heart failure, aged over 20 years and of both sexes. The pilot test was performed
with 20 patients. Furthermore, it is important to note that patients with cognitive
disorders, suspicion of psychiatric disorders, lung disease and severe
neuromuscular complications were excluded because this could affect the results.
The methodological study involved the following steps: translation, synthesis, back-
translation, review by an expert committee and pretest of the final version.
Results: After application of the pilot test, an analysis was made considering the
difference of understanding between the synthesis version into Portuguese and the
original version. In this discussion, we noticed that in Brazil some terms are not
commonly known by the population as they are in other cultures. Thus, a cultural
adaptation was crucial. The expression "health care providers" was the most
problematic; therefore, there was a need to change it to "health team". The word
"contact" also caused misunderstandings in item 22. Another problem was the
translation of item 17, because this item had many repetitions of the expression
"care providers" and of the word "care". Therefore, the structure of the sentence
was changed. Another important point was that most patients understand
"pharmacist" as a person who works in drugstores and not the person graduated in
Pharmacy. It is important to mention that these data are preliminary and were
collected in the pilot test. The study of the total sample (100 patients) is still being
conducted.
Conclusions: It is pertinent to note that in a questionnaire containing 33 questions,
few problems were found and very little was changed, which means that the unified
translated version into Portuguese is very consistent with the original version.

6. MYOCARDIAL REVASCULARIZATION IN END-STAGE RENAL DISEASE PATIENTS
MATHEUS MIRANDA; NÉLSON AMÉRICO HOSSNE JR.; LUÍS ROBERTO GEROLA; JOSÉ OSMAR DE ABREU
MEDINA PESTANA; JOSÉ HONÓRIO DE ALMEIDA PALMA DA FONSECA; ENIO BUFFOLO
Introduction : Cardiovascular diseases are the leading cause of mortality in end-
stage renal disease (ESRD) patients. The impaired renal function has been a factor
adverse in cardiac surgery, causing increased morbidity and mortality, being the
group of dialysis patients the most affected.
Objective: To analyze outcomes after coronary artery bypass grafting (CABG) in
ESRD, as well as complications in the immediate phase, trying to identify the causes
and conduct during the perioperative period.
Materials and methods: We analyzed the medical records of 43 consecutive
patients, not selected in a retrospective study underwent CABG at a tertiary public
university hospital complex from January 2002 to December 2011. The mean age
was 56.5 ± 10.2 years and 77.4% were male.
We studied the demographic and clinical characteristics, perioperative data and
complications during the hospitalization of these patients.
Result: The number of anastomosis per patient was 2.1 ± 0.8. The use of
cardiopulmonary bypass (CPB) was necessary in sixteen (37.2%) patients, the
mean CPB time 82.1 ± 31.2 minutes. The period of ICU stay was 6.8 ± 9.2 days and
the hospitalization was 12.0 ± 10.0 days. The hospital mortality was 11.6% and
morbidity of 35.1%, and the main complications was atrial fibrillation (23.2%) and
infection (16.3%).
Conclusion (Conclusion): The IRC presents itself as a risk factor for increased
morbidity and mortality. The exacerbated inflammatory response in this group of
patients, with consequent increase in the overall atherosclerotic process, can be
responsible for this increase. CABG mortality in ESRD have high hospital mortality
and should be considered metabolic aspects of this special group of patients for
intraoperative guidance of conduct.

8. THE TREATMENT OF VENOUS ULCERS IS EFFECTIVE RESOLUTION IN SUS?
CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID; ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID;
TALITA MACHADO BOULHOSA - UNICID; ANA CAROLINA MATIELI - UNICID
Introduction: venous stasis ulcer (UEV) represents about 70% to 90% of cases of
leg ulcers and features as the main cause chronic venous insufficiency. This
unsuitability of the venous system is common in the elderly population, the
frequency being greater than 4% among the elderly over 65 years of age. The high
number of recurrences of ulcers (66%) is one of the most important problems in
the care of patients with venous insufficiency. Patient education, in this situation, it
is a priority in nursing care. It is estimated that the cost for the treatment of venous
ulcers is 1 billion U.S. dollars.
Objective: To determine the characteristics of patients with UEV and identify the
types of treatment used and the evolution with treatment.
Methodology: This is a descriptive, exploratory cross-sectional. 25 records have
been identified in Mairiporã Polyclinic. However, it was necessary to follow the
routine of dressing room and interview 16 patients due to lack of data. These were
grouped into categories: profile of patients with UEV, gender, form of expression,
location, sensitivity, time of the wound, presence of associated diseases limitations;
treatments; evolution with treatment category of the professional who performs it.
Results: Evaluation UEV is not systematic, there is concern on the part of the team
to describe the evolution of the wound, but only reported by printing the patients
and the nursing assistant. Among the 16 respondents with UEV: 43.75% are males
and 56.25% were females, average age 62 female and 56 year old average male,
40% and 60% spontaneous demonstration by trauma, 100% LL -1 / 3 distal leg,
66.66% have some kind of pain, time interval UEV less than 12 months to 19 years,
35.71% have UEV and do not take even one type of medication for chronic venous
insufficiency and 64.29% have other associated diseases - diabetes mellitus and
hypertension, 100% reported limitation - 40% retired for invalides; healing in the
clinic: Povidone-iodine (PVP), 0.9% saline solution, bandages, gauze, silver
sulfadiazine cream, Vaseline, xylocaine, 56.25% of the dressings at the Polyclinic
only at home on weekends, while 43.75% home and twice / week only in the clinic,
the first 77.77% reported improvement with the dressing, the second 85.71%
reports stagnation; dressings performed by nursing assistants.
Conclusion: Pointing to the need to do a better report in the medical records of
patients (to develop a protocol): there is no specific description about the existence
of the injury, manifestation, progression, treatment and prognosis. The literature
indicates that the cleaning of the wound must be done with warm 0.9% saline
solution to facilitate cell division in the human body, with physiological
temperature of 37 ° C, however, this does not occur due to lack of local structure to
adequately fulfill the criteria for treatment and all patients make the dressing at
home, without supervision by the health professional.

9. THE SOCIAL IMPACT IN PATIENTS WHO HAD HEMORRHAGIC STROKES, AT THE
UNIDADE BÁSICA DE SAÚDE JARDIM CUMBICA I
ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;
TALITA MACHADO BOULHOSA - UNICID; ANA CAROLINA MATIELI - UNICID
Introduction: The term Cerebrovascular Accident (CVA) is currently employed to
describe a group of diseases that present an abrupt start and provoke neurological
damages due to disturbance in the blood supply to the brain. They are the second
cause of death worldwide and the most devastating when it comes to
atherosclerosis complications. Risk factors include: high blood pressure, age,
ethnicity, gender, Mellitus diabetes, alcohol consumption, birth control pills usage,
smoking, obesity and stress.
Objective: Following a bedridden patient, due to a Hemorrhagic Cerebrovascular
Accident, at the Unidade Básica de Saúde Jardim Cumbica I in order to observe and
study its neurological sequelae, as well as the impact on his social insertion.
Methods: After the analysis of all the data concerning the neurological patients at
the UBS Jardim Cumbica I, from August to September 2010, a case was selected due
to the clinical picture it presented and the chronological proximity of the
neurological accident that would enable a more accurate short term sequelae study.
The patient was then visited at his residency where the group proceeded with a
neurological anamnesis and throughout physical and neurological examinations to
insure all the necessary data for the case study. It was then presented at
Universidade Cidade de São Paulo, in November 2010, for a board of professors,
including Neurologist PhD Ana Claudia Picollo. The patient is currently in a
wheelchair, with hemiparesis of the right limbs, using captropil 25 mg/day and
Dexalgem IM every five days. In the physical examination, the main alterations
found were: slow and impaired speech, bitemporal hemianopsy, absence of the
photomotor and the consensual reflexes for the left eye, rightward deviation of the
face and a diminishing in the trophism and muscular tone of the affected side.
Considerations and Intervention Proposals: During the preparation of the case
study presentation, several articles on the subjects were reviewed. Based on them,
we can say that 15% of the patients that survive NCA present no sort of incapacity.
However, that leaves us 85% of them that do. 37% of the patients that surve NCA
present discrete incapacity -they are unable to continue performing their
professional activities but do not require help with their daily activites; 16%,
moderate incapacity requiring some kind of help with simple chores - and 32%,
slightly intense or severe incapacity - being bedridden or in a wheelchair, usually in
need of constant care. Therefore, a considerate amount of these patients depend
physically, emotionally and financially on their care takers. Thus, we concluded the
case study pointing out the importance of regular visitations to these patients by a
team of different professionals (nutritionist, physiotherapist, psychologist, nurses
and doctors among others) in order to prepare the care taker, minimize the impact
of the

10. REGIONAL INFLUENCES PARTIALLY EXPLAIN THE HIGH BREAST CANCER RISK OF
BRCA1/2 CARRIERS IN THE NORTHERN NETHERLANDS
JANET R. VOS - DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL
CENTER GRONINGEN; DORINA M. VAN DER KOLK - DEPARTMENT OF GENETICS, UNIVERSITY OF
GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; MARIAN J.E. MOURITS - DEPARTMENT OF
GYNAECOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; NATALIA
TEIXEIRA - DEPARTMENT OF GYNAECOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL
CENTER GRONINGEN; LIESBETH JANSEN - DEPARTMENT OF SURGICAL ONCOLOGY, UNIVERSITY OF
GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; JAN C. OOSTERWIJK - DEPARTMENT OF
GENETICS, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; GEERTRUIDA H.
DE BOCK - DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL
CENTER GRONINGEN
Introduction: The breast cancer risk of female BRCA1 and BRCA2 mutation carriers
by age 70 varies between 35-85% worldwide, and between 60-80% in the
Netherlands. In the Northern Netherlands these risks are relatively high at 71.4%
and 87.5% respectively. So far this higher risk cannot be explained. One of the
hypotheses is that the high risk among female carriers in the Northern Netherlands
is due to their geographical location. Therefore we studied the regional influences
on breast cancer risk using updated breast cancer penetrance rates in this region.
Methods: A consecutive prospective cohort study was conducted at our Family
Cancer Clinic, including all female BRCA1/2 carriers (N=1052) and first-degree
relatives (FDR) of carriers. Kaplan Meier analyses were used to estimate the breast
cancer risks. Censoring was applied at the age of prophylactic mastectomy (N=188),
the age at risk-reducing salphingo-oophorectomy (when performed before the age
of 50) (N=242), at the last follow-up or at death. Odds ratios were used to compare
the breast cancer incidences of mutation carriers ànd of women in the general
population in the Northern Netherland with those from the rest of the Netherlands,
using data from a previous study of a population of carriers including the
Netherlands and data from the national Comprehensive Cancer Centre respectively.
R
Results: 670 women developed breast cancer: 481 (72%) in BRCA carriers and 172
(26%) in not-tested FDRs. The cumulative incidence of breast cancer by age 70 for
BRCA1 and BRCA2 carriers was 73.9% (95%CI 69.4-79.6%) and 77.7% (95%CI
70.3-85.1%), respectively. BRCA carriers in the Northern Netherlands were more
likely to develop breast cancer than BRCA carriers in the rest of the Netherlands,
OR=1.93 (95%CI 1.67-2.24). Females in the general population in this region had a
small increased risk to develop breast cancer, OR=1.07 (95%CI 1.01-1.13).
Conclusion: BRCA1/2 mutation carriers in the Northern Netherlands are at a higher
risk to develop breast cancer and this cannot sufficiently be explained by regional
differences in background breast cancer incidence. Further research should aim to
elicit other factors such as founder mutations, population specific modifiers or
lifestyle factors.

11. COLORECTAL CANCER SCREENING BY HUMAN DNA STOOL QUANTIFICATION
YOLANDA MAROTO TEIXEIRA - UNIFESP; JACQUELINE MIRANDA DE LIMA - UNIFESP; NORA
MANOUKIAN FORONES - UNIFESP
Background: The colorectal cancer (CRC) tends to increase with population aging
reaching currently 1 million cases with 500.000 deaths around the world. In Brazil,
the estimation for this year is 30.140 new cases with 12.471 deaths that make this
neoplasia the fourth cause of death in the country. Colonoscopy and fecal occult
blood (FOBT) test are largely used for colorectal cancer screening. However, the
FOBT had a low sensibility and the colonoscopy is expensive and brings great
inconvenience to the subjects. New methods involving the DNA of the stools are
being studied to increase the diagnosis of cancer with a noninvasive method.
Aim: Quantification of the human DNA of the stools of patients with colorectal
cancer.
Methods: We analyzed 97 stool samples of patients, divided in two groups: 51
individuals without CRC that form the control group and 46 patients with colorectal
cancer, which form the case group. All the patients from the control group had been
submitted to colonoscopy. PCR Real Time was utilized, through the quantification
method by amplification of specific sequences of DNA (Quantifier Human Standard -
Applied Systems) and by comparison between these groups. Also to compare the
quantification by amplification, we used the fluorescent spectrophotometry. The
total DNA of the stools had also been quantified.
Results: The mean total DNA from the stools of the CRC patients was 91.1ng/µL
(SD=57.8) and of the control group was 109.7ng/µL (SD=95.3), (p>0.05). The
mean human DNA quantification of the case group was 15.03ng/µL (SD=30.7) and
for the control group 0.47ng/µL (SD=1.02). This difference between both groups
was significant (p<0.0001). Patients with colorectal cancer localized on the
descendent, sigmoid and rectum had a higher mean concentration of human DNA
(18.32ng/µL) when compared to the CRC localized in the ascendant or transverse
(1.10ng/µL) (p=0.0027). In the analysis of tumor invasion, we did not find
differences in the quantification of DNA of T1, T2 and T3 tumors compared to T4
tumors (p=0.86). There were no correlation between the total quantification of DNA
and the human DNA quantification in the stools in both groups case and control by
the Spearmans rank correlation test (p=0.16 and p=0.21, respectively).
Conclusions: Patients with colorectal cancer had significant more quantities of
human DNA compared to patients without cancer. Higher quantities of human DNA
were found in patients with distal CRC.

13. OPERATIVE VERSUS NONOPERATIVE PROCEDURE IN THE TREATMENT OF
PENETRATING ABDOMINAL TRAUMA
ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;
TALITA MACHADO BOULHOSA - UNICID
Introduction: Penetrating abdominal trauma is the main cause of trauma admission
in the US. Patients with stabbing injuries are thrice more common than by firearm,
albeit a lower mortality rate4; 82% are male; 18%, female and they are, in average,
32.8 years. By the mid 1960s, laparotomy was the standard procedure for these
injuries but advances in diagnostic and image procedures have contributed to the
adoption of new ones1. OBJECTIVE Compare operative and nonoperative
management treatment of penetrating abdominal trauma; establish a necessary
management algorithm.
Methodology: This literature review was conducted between February and June 11,
based on articles published between 06 and 11; selected at the PubMed and Bireme
databases using terminology registered in the Health Sciences Descriptors:
laparoscopy, laparotomy, penetrating abdominal trauma. Studies related to the
therapeutic approach of laparotomy and (or) laparoscopy in penetrating abdominal
trauma and comparative ones were included; those that demonstrated its use in
children were excluded.
Results: There are three main procedures related to penetrating trauma of the
abdomen (anterior and posterior): immediate surgical management, extended
surgical procedure and nonoperative. The immediate surgical is recommended for
patients who shows signs of shock, hemodynamic instability, evisceration, and
peritonitis. 50-75% of penetrating trauma in the anterior abdomen caused by
weapons cross the peritoneal cavity, and of this 50-75% require surgical repair. The
liver (73%), the kidney (30.3%) and the spleen (30.3%) are the most affected
organs. Velmahos et al (2011) showed that out of 1405 patients with gunshot
wounds in the anterior abdomen, 484 had non-operative management (34%); 65
were submitted to extended laparotomy (13.4%) after developing signs and
symptoms and 17 underwent non-therapeutic laparotomy. Penetrating trauma to
the posterior abdomen is less likely to present significant injury but they complicate
the evaluation of the retroperitoneal organs through physical examinations and
FAST. In stable patients, CT is a safe choice4. Peritoneal integrity can be evaluated
clinically, through CT, FAST, diagnostic peritoneal lavage or laparoscopy. Such
methods reduce the use of explorative laparotomy, immediate and extended,
leading to an increase in non-surgical intervention3. Thus, when the rate of
exploratory laparotomy decreases, so does the immediate, the extended and the
negative laparatomies, as well as mortality, complications, length of stay and
hospital costs. Conclusion: This review concluded that less invasive methods are
safe and effective in treating penetrating trauma to the abdomen. Although there
are few long-term studies, the literature indicates an association of the decrease in
the rate of surgical interventions and of negative laparotomy and of potential
surgery related complications, hospital costs and length of stay of patients.

14. TEACHING AND LEARNING BIOPSY AND SUTURE SKILLS DURING MEDICAL
GRADUATION BY INSTRUCTOR-DIRECTED TRAINING ON BENCH MODEL: A
RANDOMIZED CONTROLLED STUDY COMPARING LOW AND HIGH FIDELITY BENCH
MODELS
Rafael Denadai¹, Lucas Denadai², Marie Oshiiwa³, Rogério Saad-Hossne⁴
1 MD, Fellow of Surgery, Division of Coloproctology, Department of Surgery,
Botucatu Medical School, UNESP, Botucatu-SP; Fellow of Research, Institute of
Plastic and Craniofacial Surgery, Hospital SOBRAPAR, Campinas-SP; and Resident,
Department of Surgery, Hospital Municipal Dr. Mário Gatti, Campinas-SP, Brazil
2 Graduate student, Faculty of Medical Sciences, UNIFESP –EPM. São Paulo, Brazil
3 PhD, Associate Professor, Department of Statistics, FATEC, Marilia-SP, Brazil
4 MD, PhD, Associate Professor, Division of Coloproctology, Department of Surgery,
Botucatu Medical School, UNESP, Botucatu-SP, Brazil
Introduction: As the training of basic surgical skills training on live patients (traditional
apprenticeship model) may violate ethical and medico-legal aspects, learning technical
skills on inanimate bench models is becoming widely used during medical education. These
inanimate simulators vary widely regarding their level of fidelity to living human patients.
High-fidelity simulators (e.g., pig, rat, and chicken skins) are limited by high costs, low
availability, potential for transmission of infectious disease, and ethical concerns and
lower-fidelity synthetic simulators such as ethylene-vinyl acetate (EVA) plates and
polyurethane foam sacrifice "realism" for portability, lower costs, and potential for
repetitive use. Despite the intuitive belief that "the more realistic is the better" within
surgical simulation this cannot be based only on subjectivity. Therefore, the purpose of this
study was to assess objectively if the fidelity of bench models interferes with the
acquisition of cutaneous surgical skills (biopsy and suture) by novice medical students.
Materials and Methods: The design was a randomized controlled study with blinding of
expert examiners, including a session of verbal teaching based on instructional video, a pre-
test, a 2-hour practice phase, and a post-test. The pre- and post tests were identical and
consisted of the manufacture of 5 simple interrupted sutures (bidimensional) and 1
running subcuticular suture (tridimensional) for the closure of two elliptical incisions
measuring 8x2 cm each on ox tongue and an elliptical excision (marking of safety margins
forming an ellipse, incision and excision of the "tissue") for the "diagnosis and treatment" of
a "non-melanoma skin cancer" measuring 1cm in diameter simulated on ox tongue. Each
student was tested individually. No verbal feedback was provided during both pre- and
post-tests. Thirty six medical students with no surgical skills background (novices) were
randomized to 3 groups (n=12): didactic training alone (control); low-fidelity cutaneous
surgical training (plates of 4mm of EVA); or high-fidelity cutaneous surgical training (pig
feet skin). All students trained biopsy and sutures in a repetitive and deliberative manner
directly supervised by an experienced faculty surgeon (one instructor for each four
students). Objective evaluation based on Global Rating Scale with blinded assessment and
self-perceived confidence based on Likert scale were used to assess all performances in
pre- and post-training. Values were considered significant for a confidence interval of 95%
(p<0.05). Effect sizes were also calculated in order to identify the magnitude of the
intervention effect regardless of the sample size; effect sizes exceeding 0.80 were
considered large.

15. Results: The post-training analysis showed that the students that practiced on bench
models (hands-on training) presented better (all p<0.0000) performance in the Global
Rating Scale evaluation, compared with the control, regardless of the model fidelity; there
was no significant difference (all p>0.05) between the groups that trained on bench models.
The magnitude of the effect (training) was considered large (>0.80) in all measurements.
Students felt more confident (all p<0.0000) to perform both procedures after training.
Conclusion: The acquisition of biopsy and bi- and-tridimensional suture skills after the
instructor-directed training on low-fidelity bench models was similar to the training on
high-fidelity bench models, and there was a more substantial increase in the performances
of students that received bench model training compared to the learning on didactic
materials.

16. IS IT SAFE AND EFFECTIVE TO TREAT COMPLEX RENAL CYSTS BY THE
LAPAROSCOPIC APPROACH?
REBECCA SUBIRA MEDINA - ESCOLA PAULISTA DE MEDICINA - UNIFESP; CASSIO ANDREONI - ESCOLA
PAULISTA DE MEDICINA - UNIFESP; VALDEMAR ORTIZ - ESCOLA PAULISTA DE MEDICINA - UNIFESP;
THOME PINHEIRO JR. - ESCOLA PAULISTA DE MEDICINA - UNIFESP; RICARDO NATALIN - ESCOLA
PAULISTA DE MEDICINA - UNIFESP; FABIO SEPULVEDA - ESCOLA PAULISTA DE MEDICINA - UNIFESP
Background and Purpose: Bosniak III and IV renal cysts have low mortality
potential, and little is reported regarding the feasibility and safety of managing such
tumors by laparoscopy and its comparison with open surgery. We report on the
experience with 37 complex renal cysts managed in the era of laparoscopy.
Patients and Methods: A retrospective analysis of a prospective database from all
patients with renal tumors who were operated on at our institution was evaluated
after Institutional Review Board approval. The database comprises information for
demographic, clinical, imaging, preoperative, intraoperative, histologic, and follow-
up data. A comparison among all performed approaches was done for demographic,
American Society of Anesthesiologists classification, operative time, estimated
blood loss, ischemia time, hospital stay, oncologic and survival rate. The cysts
removed by laparoscopic partial nephrectomy were compared with the solid
tumors removed by the same approach at the same period.
Results: The database included 407 patients with renal tumors who were operated
on from 2000 to 2009 at our institution. In 36 patients of the total cohort, there
were 37 complex renal cysts. No patients with preoperative Bosniak type I or II
underwent surgery. Of the cysts, 60% were Bosniak IV, and 86% were confirmed as
malignant; 40% were Bosniak III, and 44% were confirmed as malignant.
Laparoscopic partial nephrectomy was performed in 67.5%. The tumor size and
hospital stay were significantly different in the laparoscopic group. No cyst spillage
occurred either by laparoscopy or by the open approach, and no tumor recurrence
was found in a mean follow-up of 43.7 months with overall survival of 100%.
Conclusion: Laparoscopic surgery for complex cysts is safe, feasible, and effective.
Nevertheless, regardless of surgical approach, patients with complex renal cysts
have excellent overall survival with short-term follow-up.

18. END-STAGE CARDIOMYOPATHY AND SECONDARY MITRAL INSUFFICIENCY
SURGICAL ALTERNATIVE WITH PROSTHESIS IMPLANT AND LEFT VENTRICULAR
RESTORATION
ALINE COUTO CARNEIRO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DE SÃO PAULO;
JOÃO NELSON RODRIGUES BRANCO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DE
SÃO PAULO; JOSE HONÓRIO DE ALMEIDA PALMA FONSECA - ESCOLA PAULISTA DE MEDICINA,
UNIVERSIDADE FEDERAL DE SÃO PAULO; JOÃO ROBERTO BREDA - FACULDADE DE MEDICINA,
UNIVERSIDADE FEDERAL DO ABC; ROBERTO CATANI - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE
FEDERAL DE SÃO PAULO; ENIO BUFFOLO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DE
SÃO PAULO
Background: Secondary mitral insufficiency is a strong risk factor for death in end-
stage cardiomyopathy. The possible correction of mitral regurgitation has now been
accepted as an alternative to cardiac transplantation in a special subset of patients.
We propose a new surgical approach that consists of implantation of a mitral
prosthesis that is smaller than the annulus, and preservation and traction of the
papillary muscles to reduce sphericity of the left ventricle.
Methods: Between December 1995 and October 2011, 155 patients with dilated
cardiomyopathy underwent this procedure, with the following etiologic factors:
ischemic (98), idiopathic (54), Chagas disease (1), viral (1), and postpartum (1). The
patients were analyzed according to clinical criteria, echocardiographic findings,
and morphology of left ventricle.
Results: All patients were in an end-stage phase, requiring hospital admissions over
the past 6 months, despite receiving full medication. Furthermore, seven were in
intensive care unit receiving intravenous drugs or intra-aortic balloon
counterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.1%
(25/155), yet midterm follow-up showed a relatively flat late survival curve, with
evidence of improved clinical status, better echocardiographic parameters, and
reduction in ventricular sphericity.
Conclusions: The high early mortality rate related to other clinical conditions at the
time of surgery. However, the resultant flat survival after this early interval offers a
promising long-term therapeutic alternative for the treatment of patients in
refractory heart failure with cardiomyopathy that is associated with moderate or
severe secondary mitral regurgitation.

19. SEVERE EPISTAXIS: DIAGNOSIS PROTOCOL AND ENDOSCOPIC SURGERY
TREATMENT IN 59 PATIENTS
BEATRIZ BRITTES KAMIENSKY - FURB; EDUARDA RAQUEL PRZYGODA ALVES - FURB; HADELLE
HABITZREUTER HASSMANN - FURB; JAN ALESSANDRO SOCHER - FURB
Introduction: The severe epistaxis is considered one of the most common
emergencies it the otorhinolaryngologist (ENT) practice and common cause of
hospital internment, including risk of life. The conventional treatment is nasal
splints, but it causes pain, nasal obstruction and significant morbidity. Therefore the
endoscopic techniques become the diagnosis more accurate and the treatment
more effective. Objective: To describe and discuss emergency care protocol for
topographic diagnosis and endoscopic surgical treatment performed on patients
with severe epistaxis.
Material and methods: During the period between March 2004 and February 2012,
59 patients who sought specialized service with severe epistaxis were treated
endoscopically. The patients had undergone an endoscopic exam for topographic
diagnosis and then set the point to cauterization of the bleeding or ligation of the
sphenopalatine artery and/or anterior ethmoid. In suspected cases the diagnostic
workup was performed using computed tomography. All patients were operated
with endoscopic optics 30 and 45 degrees and suitable material for dissection and
ligation.
Results: A total of 36 cases of epistaxis were associated with nasosinusal post-
operative complication, 20 spontaneous cases and 3 cases of posterior epistaxis
related to nasosinusal tumors. In 49.1% of cases were identified posterior epistaxis
and required ligation of the sphenopalatine artery and its branches in 29 patients.
In 17% of cases were identified superior epistaxis and was required ligation of the
anterior ethmoid artery in 10 patients. In 22% of cases did not identify precisely the
focus of epistaxis and thus it was necessary ligation of sphenopalatine and anterior
ethmoidal arteries in 13 patients. In 8.4% of cases was founded bleeding point at
tail or body of the inferior turbinate requiring cauterization in 5 patients. In 3.3% of
cases identified in the posterior septum bleeding requiring cauterization of the
same in two patients. No patient had a new episode of epistaxis postoperatively and
was discharged generally between 8 to 48 hours.
Conclusion: The use of the endoscope has proved to be a useful tool to aid in the
topographic diagnosis and endoscopic surgical techniques were safe and effective in
the treatment of severe epistaxis.

20. PAIN PROFILE IN TRAUMATIC BRACHIAL PLEXUS INJURY PATIENTS IN TWO
BRAZILIAN PAIN CENTERS
MATHEUS GOMES SILVA PAZ - FEDERAL UNIVERSITY OF BAHIA; MAURO TUPINIQUIM BINA - FEDERAL
UNIVERSITY OF BAHIA; SCHEILA NOGUEIRA SANTOS - FEDERAL UNIVERSITY OF BAHIA; ABRAH FONTES
BAPTISTA - FEDERAL UNIVERSITY OF BAHIA
Introduction: Traumatic brachial plexus injuries (TBPI) may occur by compression
or traction (95% of cases), being more frequent in the supraclavicular region (70 to
75% of cases). Pain is a common symptom in TBPI, which manifests itself as
complaints of burning, shooting sensation, painful sensation or tightness. This study
intended to determine pain profile and characterization in patients with traumatic
brachial plexus injury in three brazilian pain centers.
Materials and Methods: This was a cross-sectional study with consecutive patients
who suffered non-obstetric traumatic brachial plexus (TBPI) recruited from the
Upper Limb Injuries Clinic of the University Hospital Prof. Edgard Santos, UFBA, and
Nerve Clinic of the Institute of Psychiatry, FMUSP, from August 2011 to January
2013. Pain was the dependent variable and the independent variables were socio-
demographic data and health information related to the TBPI, anxiety/depression
and quality of life. Muscle strength and range of motion were also assessed and pain
pressure threshold evaluations were done based on Quantitative Sensorial Testing.
Possible confounding factors were excluded (neurological comorbidities and
history of neurological diseases). The chronological and clinical-surgical aspects
were used as stratification parameters.
Results: From August 2011 up to January 2012, 12 patients were recruited (81,71%
were men). Patients aged 30,21±10,23, had 5,07±1,94 years of study and the mean
BMI was 26,83±5,68. Half of the patients were from C1 social class and most were
married/living together (57,14%); 78,57% were removed from their jobs and
71,42% received some kind of social benefit. All were injured in a traffic accident,
involving a car accident (1) or motorcycle accident (11). The mean time of
assessment was 51,17±27,89 weeks after injury, but the mean time of medical
assistance was 47,29±29,49 weeks. Just 3 patients were not undergoing
physiotherapy sessions and 9 patients had to use some auxiliary device for
treatment. Although pain was moderate (VAS: 51,67±33,85), disability was the most
important bothering factor for 66,66% of patients. Eight patients felt pain every day
and the most common pain location was the hand ipsilateral to the lesion, 50%., and
the mean time of pain was 46,58±31,70 weeks until the assessment. Five patients
used a combination of medicines for the treatment and three used none.
Conclusion: Patients with traumatic brachial plexus injury are usually young men,
with low educational and socioeconomic level and married. In most of&nbsp;the
cases the lesion impeded their work activities. The most prevalent cause of lesion
was motorcycle accident. Although pain was moderate to intense, the most
troublesome for the patients are the functional impairments. Pain is usually treated
by a combination of medications and physiotherapy.

21. VISUAL FUNCTION AMONG THE BRAZILIAN OLYMPIC JUDO TEAM
PRISCILA RODRIGUES LEITE OYAMA - UNIFESP - ESCOLA PAULISTA DE MEDICINA; BERNARDO KAPLAN
MOSCOVICI - UNIFESP - ESCOLA PAULISTA DE MEDICINA; PAULO SCHOR - UNIFESP - ESCOLA PAULISTA
DE MEDICINA
Introduction: Medical evaluation of high performance athletes aim to identify
general and specific findings of each sport. Sportive ophthalmology analyzes the
visual function and the impact on the performance in the sports practice. The visual
function is basically measured quantitatively by visual acuity(VA)and qualitatively
by aberrometry, measuring the high order aberrations in RMS(HOA).There are
plenty of others exams to contribute to evaluate the visual function, like: Visual
field(VF-which indicates if the athlete has peripheral vision); Titmus (which
indicates if they have binocular vision and sense of depth)and Spheric
Equivalent(SEequal to the algebraic sum of the value of the sphere and half the
cylindrical value of the ametropy of the patient).Judo is a sport with physical
contact and depends on the speed, reflexes, strength and technique. The quality and
quantity of vision could influence on this sport. We also believe that the peripheral
vision and sense of depth could have influence on the success of the athletes,
improving the ability of judo fighters. The high SE indicates that the athlete might
have problems achieving a good vision without glasses.
Materials and Methods: All exams made with the Brazilian Olympic judo team were
performed by the residents and technologists of the depertment of ophthalmology
of UNIFESP sequentially,in the same day and location. It has been evaluated the VA,
with and without correction,refraction,titmus,aberrometry and visual field of
thirteen judo athletes. All of them were man,except for one female judoka,with age
26,2 years(ranged from 22 to 34 years). Ladarvision Wavefront was used to
measure aberrometry and only the high order aberrations RMS was
considered.Values above 0.5 were considered abnormal. For the visual fiels it was
used the Humphrey perimeter under the 750I strategy and the Anderson criteria to
classify into normal and abnormal exams. The titmus exam was performed by the
same examiner on the same illumination conditions and normal values considered
until 60.
Results: All visual field exams were normal. The HOA ranged between 0,15 -
1.32,being altered only in one patient with keratoconus diagnosis. Nine patients had
titmus of 40(maximum),two 50 and one 60, only one patient had titmus of
200(same patient with keratoconus).The keratoconus patient had poor distance
vision(20/60 in the right eye,20/25 in the left eye),even with correction, and SE
higher than 4 diopters in the right eye. Beside this patient only one patient had SE
higher than 1 diopter(1.125),but had normal vision.
Conclusions: Only one patient,with suspect keratoconus, showed altered values in
the exams and more prominent in only one eye, nevertheless he had altered titmus
values, which means he might had problems in sense of depth. All other patients
presented normal exams and most of them with good HOA. The ophthalmologic
exam in athletes is important to identify factors that could influence in their
performance and help to solve them.

22. THROMBOEMBOLIC EVENTS AFTER KIDNEY TRANSPLANTATION
RENATO DEMARCHI FORESTO - FEDERAL UNIVERSITY OF SÃO PAULO; MAURÍCIO ISAAC PANICIO -
FEDERAL UNIVERSITY OF SÃO PAULO; MILA SALENAVE - FEDERAL UNIVERSITY OF SÃO PAULO; TAINÁ
SANDES FREITAS - FEDERAL UNIVERSITY OF SÃO PAULO; HÉLIO TEDESCO JR - FEDERAL UNIVERSITY OF
SÃO PAULO; JOSÉ MEDINA PESTANA - FEDERAL UNIVERSITY OF SÃO PAULO
INTRODUTION: Venous Thrombosis (VT) and Pulmonary Embolism (PE) are
important causes of morbidity and mortality in hospitalized patients. Studies show
that patients undergoing kidney transplantation have increased risk to develop
thromboembolic events, however, there are a few data in literature about incidence,
risk factors and recurrence rate of VT/PE in these patients. The objectives were to
assess the profile of patients with thromboembolic events and to identify possible
risk factors and recurrence rate of VT/PE.
MATERIALS AND METHODS: We conducted a retrospective records analysis of
renal transplant patients who presented an episode of VT/PE until the sixth month
after transplantation. We analyzed historical medical records of Hospital do Rim e
Hipertensão from January/1998 to December/2010. Data were analyzed by
descriptive statistics, with results expressed as proportions for categorical variables
and means for numerical variables.
RESULTS: From January/1998 to December/2010, 7,147 renal transplants were
performed in our hospital, of which 65 were related with VT/PE events until the
sixth month of transplantation (deceased donor: 34 / living donor: 31). We
observed a peak incidence in the second month of transplantation, and 7 patients
presented a second thromboembolic event on average 23 months after the first
event (2-108 months). The mean age of patients was 49 years (28-68 years), with
male predominance (2:1), 55% hypertensive, 15% diabetic, 10% obese, 6%
smokers, 6% had a previous thromboembolic event, 4% had previous diagnosis of
heart failure, and 4% had erythrocytosis at diagnosis. All patients were taking
calcineurin inhibitor in immunosuppressive regimen (17% Cyclosporine, 83%
Tacrolimus), associated with antiproliferative (40% Azathioprine 40%
Mycophenolate Mofetil) or m-TOR inhibitor (20%). The fatality rate for PE was
47%.
CONCLUSION: We observed that all of our patients presented at least one risk factor
to thromboembolic event. Most thromboembolic events occurred in the first 2
months after transplantation suggesting a risk assigned by the surgery itself. The
recurrence rate in this study was lower than that reported in literature, however,
high rate of mortality due to PE points to a need for further studies to define the
real incidence of VT/PE in this population and to identify the patients most at risk
to thromboembolic events.

24. ADRESSING CELL PROLIFERATION IN THE SUBEPENDYMAL ZONE IN THE
EXPERIMENTAL AUTOIMMUNE ENCEPHALOMYELITIS MURINE MODEL OF
MULTIPLE SCLEROSIS
Alberto Silva, Ana M. Falcao, Sandro Mesquita, Joana A. Palha, Fernanda
Marques, Life and Health Sciences Research Institute (ICVS), School of Health
Sciences, University of Minho
Aim: To address whether current treatment for multiple sclerosis, namely with
natalizumab, influences cell proliferation in the subependymal zone (SEZ), in the
experimental autoimmune encephalomyelitis murine model of multiple sclerosis
(EAE).
Background: The subependymal zone (SEZ) is one of the major sites of
neurogenesis in the adult brain. While these cells usually migrate through the
rostral migratory stream towards the olfactory bulb, they can also be mobilized to
other brain regions and differentiate into various cell types. Such seems to be the
case in EAE where cells originating from the SEZ have been shown to originate
oligodendrocytes that may regenerate damaged neurons.
Methods: EAE was induced in female SJL mice All mice were weighed and scored
daily for the appearance and severity of the symptoms. Treatment was at the onset
phase of the disease, with natalizumab (5mg/Kg), a humanized monoclonal
antibody used as therapeutic approach to MS, that blocks the passage of T and B
cells from the immune system to the brain parenchyma because this antibody is
against integrin α4. A group of mice received control rat IgG (control for the
treatment). Control animals were not treated with natalizumab because they do not
show any symptoms. Animals were sacrificed when symptoms were reverted in the
treatment group, brains frozen and cut in 20 ìm slices for immunohistochemistry
against Ki‐67, a cellular proliferation marker. Sterological analysis is ongoing to
determine SEZ proliferation and ectopic migration.
Results: Present data show that natalizumab successfully reverted the EAE
phenotype. Preliminary data suggest that treatment control group, which was only
induced with EAE and not treated with natalizumab, decreased the number of
Ki‐67+ cells in the SEZ but increased its number in SEZ vicinity. Treatment with
natalizumab leads to an increase in the proliferation rate of the SEZ and a decrease
in the number of cells in proliferation in the vicinity of the SEZ.
Discussion/Conclusions: CNS lesions, as MS, modulate cell proliferation in the SEZ.
This modulation in relapse/remising model seems to be different from the EAE
chronic models. In the EAE model of relapse and remission an increase in cell
proliferation in the vicinity of SEZ is observed and a decrease of cells Ki‐67+ in SEZ,
which may occur in order to repair the damaged foci. Natalizumab seems to
increase cell proliferation in SEZ but slightly decreases in the vicinity.

25. EFFECT OF DIETARY LIPIDS ON PROTEIN-ANATOMICAL AND HISTOPATHOLOGICAL
PARAMETERS OF THE ORGANS OF RATS AT BIRTH, END OF LACTATION AND
ADULTS.
ANA CRISTHINA RIBEIRO NOVAES - UNIVERSIDADE DE UBERABA; MORGANNA FERREIRA IDÁLIO SILVA -
UNIVERSIDADE DE UBERABA; TIAGO CANEU ROSSI - UNIVERSIDADE DE UBERABA; RICARDO HENRIQUE
ALMEIDA BARBOSA - UNIVERSIDADE DE UBERABA; KAMILA BOTELHO FERNANDES DE SOUZA -
UNIVERSIDADE DE UBERABA; GERALDO THEDEI JÚNIOR - UNIVERSIDADE DE UBERABA
Introduction: Excess weight is a global problem that affects about 50% of the adult
Brazilian population. Diets high in protein and low in fats and carbohydrates are
used for the purpose of weight reduction. However, these diets can cause damage to
metabolism. Studies have shown that they may predispose the formation of
atherosclerosis, type 2 diabetes and hepatic steatosis. Recent experimental studies
have demonstrated effects caused by dietary lipids, protein consumed during
pregnancy and lactation and their effect on litter.
Aim: to determine the effect of a diet low in protein, lipids carbohydrates consumed
during pregnancy and / or lactation on anatomical and histopathological
parameters of the spleen, brain, heart, kidneys and testes of young Wistar rats,
comparing with a balanced diet.
Materials and Methods: For this purpose, 32 pregnant rats and their pups were fed
a diet balanced to control rats (C) or experimental diet (E, consisting of 5% CHO,
45% and 45% TAG PTN) ad libitum during pregnancy and / or lactation forming
thus, four groups: DC, EC, EC, EE. After weaning, the animals received only C diet
until adulthood (12 weeks old). They were euthanized, and organs were removed,
fixed in formaldehyde and a sample subjected to routine histopathological analysis,
with staining by hematoxylin-eosin (HE). The statistical analysis of the results was
performed in 14.4 software STSS by the Chi - square test with p &lt;0.05.
Results: Histopathological analysis of pups at the end of lactation showed
hyperplasia of white pulp (p &lt;0.05) in the spleens of animals from groups EE and
CE. In the hearts showed the occurrence of inflammation with a significant
percentage in subgroups CE and EE (p &lt;0.05). In both the comparison was
compared to the CC group. Anatomopathological analysis of the puppies at the end
of the lactation period demonstrated a significant reduction of weight, in group EC
(weight 1.29 g + / - 0.03) when compared with the CC group (weight 1.47 g + / -
0.12) p &lt;0.05. Weight reduction was also present in the EC group (weight 1.90 g +
/ - 0.11), the young adults when compared to CC group (2.12 g + / - 0.08), with p
&lt;0.05 .The anatomo-histopathological analysis of kidneys and testes no showed
significant changes.
Conclusion: It is concluded that consumption of dietary lipids protein in different
life cycle phases (gestation / lactation), can significantly affect the development and
structure of spleens, brains and hearts of puppies at the end of lactation and adults
can cause future consequences.

26. OXIDATIVE EFFECTS ON PULMONARY INFLAMMATORY RESPONSE IN MICE
EXPOSED TO CIGARETTE SMOKE
EVANDRO GUEDES GONÇALVES - UNIVERSIDADE FEDERAL DE OURO PRETO; VITOR ALVES DOURADO -
UNIVERSIDADE FEDERAL DE OURO PRETO; FRANK SILVA BEZERRA - UNIVERSIDADE FEDERAL DE OURO
PRETO
Introcuction: This study aimed to analyze and compare the influx of inflammatory
cells into the lung parenchyma in animals exposed to cigarette smoke, as well as
investigate the oxidative damage in the form of lipid peroxidation in lung extracts
and the activity of antioxidant enzymes: Superoxide dismutase (SOD), glutathione
peroxidase (GPx) and catalase (CAT).
Materials and Methods: We used 36 C57BL / 6 mice, 8 weeks, divided into groups of
six animals exposed to cigarette smoke for 1 (GF1D), 2 (GF2D), 3 (GF3D), 4 (GF4D)
and 5 (GF5D) days respectively, 3 times a day and the control group (CG) was
exposed to air. Each cigarette was attached to a plastic syringe of 60 ml, which is
inflated after the smoke was expelled in the inhalation chamber 40 cm long, 30 cm
wide and 25 cm high. Each cigarette produces about 1 liter of smoke diluted with 30
liters of ambient air present in the chamber, the final concentration of 3%. After
euthanasia by cervical dislocation, were collected bronchoalveolar lavage fluid
(BALF) through the tracheostomy, the peripheral blood by cardiac puncture and
lung tissue removed through an incision in the anterior chest wall for analysis of
thiobarbituric acid reactive substances (TBARS ) and activity of SOD, GPx and CAT.
Results: There was an increase in total leukocytes in GF2D groups (1.35 ± 0.53x105
cels/ml) GF3D (2.33 ± 0.33x105 cels/ml) GF4D (3.05 ± 0.29x105 cels/ml) and GF5D
(3.4 ± 0.39x105 cels/ml) compared to control (0.31 ± 0.09x105 cels/ml) (p
&lt;0.0001), and neutrophils in peripheral blood GF3D groups (3.8 ± 0.3x104
cels/ml) GF4D (7.2 ± 0.23x104 cels/ml) and GF5D (9.3 ± 0.883x104 cels/ml)
compared to the control group (2.6 ± 0.43x104cels/ml) (p &lt;0.0001). Oxidative
damage in GF2D groups (1,017 ± 0.08545 U / mL / mg.prot) GF3D (1,037 ± 0.04204
U / mL / mg.prot) GF4D (1,050 ± 0.07565 U / mL / mg.prot) GF5D (1,206 ± 0.02734
U / mL / mg.prot) compared to the control group (0.8708 ± 0.05635 U / mL /
mg.prot) (p &lt;0.0001) were increased. The enzymatic activity of SOD in groups
GF3D (0.4767 ± 0.05207 U / mg. protein), GF5D (0.6000 ± 0.03606 U / mg.protein)
compared with control group (1.197 ± 0.07688 U / mg. protein) (P &lt;0.05) was
decreased, however the enzymatic activity of GPx GF1D groups [163.7 ± 12.88 (mM
/ min / mg ptn-1) x 10-5], GF2D [182.3 ± 14.25 (mM / min / mg ptn-1) x 10-5]
compared to the control group [115.0 ± 4.509 (mM / min / mg ptn-1) x 10-5]
(p=0,0001) was increased. well as the increased activity of catalase in GF3D groups
(24.71 ± 5.923 U / mg ptn) GF4D (23.96 ± 3.524 U / mg ptn) compared to GC (12.31
± 3.125 U / mg ptn) (p = 0.0001).
Conclusion:There was a growing influx of inflammatory cells in bronchoalveolar
lavage, blood periferies as well as oxidative damage and an increased activity of
antioxidant enzymes in animals exposed to cigarette smoke. Further studies are
necessary to assess the cellular profile of this experimental model.

27. HISTIOCYTIC SARCOMA: HISTOLOGIC AND IMMUNOHISTOCHEMICAL ANALYSIS AND
STUDY OF APOPTOSIS
RAFAEL BISPO PASCHOALINI - SÃO PAULO STATE UNIVERSITY; RODRIGO MATTOS DOS SANTOS - SÃO
PAULO STATE UNIVERSITY; FABÍOLA ENCINAS ROSA - SÃO PAULO STATE UNIVERSITY; MARIA
APARECIDA CUSTÓDIO DOMINGUES - SÃO PAULO STATE UNIVERSITY
Introduction: Histiocytic Sarcoma (HS) is a malignant neoplasia characterized by
proliferation of cells with morphological and immunophenotipical features similar
to tissue mature histiocyte. Its a rare hematopoetic malignancy, comprising less
than 1% non-Hodgkin lymphomas. The morphological heterogeneity, which
overlaps with other malignancies, both lymphoid and non-lymphoid is accompanied
by various clinical and epidemiological aspects, giving this entity a difficult
diagnosis. We theorize that in the pathogenesis of HS apoptotic pathways may be
compromised, what induces neoplasic histiocytes mortality, which despite well
differentiated presents with wide morphological aspect. This theory would
complement studies that determine morphological criteria and
immunophenotypical markers. The pathogenesis definition, associated to more
frequent morphological pattern and specific immunomarkers would assure
appropriate anatomopathological diagnosis, efficient treatment and better
prognostic.
Materials and Methods We conducted an analytical study involving morphological
and immunohistochemical features that are described for the diagnosis of HS. We
evaluated three confirmed cases from our service, which entered between 1998 and
2009. To configure the immunohistochemical panel of the test, 19 markers were
used, including those more relevant according to current literature. The
morphological study was performed with cell descriptors commonly used in
literature.
Results: It was found the relevance of 12 morphological criteria present
simultaneously in the three HS cases, which showed little variability when taken
together with others: medium to large cell size, vacuolized chromatin, irregular cell
membrane, intranuclear inclusion, vacuolar eosinofilic cytoplasm, bizarre cells
presence, cohesivity, epithelioid aspect, phagocytosis, stroma with inflammatory
infiltrate, apoptosis and hemosiderin. Setting the 19 immunohistochemical markers
panel, 5 of them showed similar results in the three cases: CD163, CD68, vimentin
and lysozime with diffuse distribution and focal S-100. The markers CD45 and CD30
were positive strictly in the skin sample. With regards to markers for disease
pathogeny, two of them showed positive results for three cases: Fas-ligand and
caspase-3. The Bax marker was negative for the evaluated cases.
Conclusion: Fas-ligand marker is an extrinsic factor in the apoptotic pathway and
presented positive for all cases. Studies show the extrinsic Fas pathway is sufficient
to induce apoptosis in some cell types. Literature reports the ligant expression in
some tumors may be an evidence of pro-inflammatory response. Microenvironment
alterations due to inflammatory processes may promote tumor growth and its
immune response evasion. Thus, our results suggest the existence of an external
factor that may lead to tumor induction, related to microenvironment, such as an
infection.

29. METALOPROTEINASE'S ROLE IN HEPARIN HEMORRHAGIC ACTIVITY
CLARA CORREA FERNANDES - UNIFESP; CAMILA DE MELO ACCARDO - UNIFESP; ANA CAROLINA GOMES
TRINDADE - UNIFESP; HELENA BONCIANI NADER - UNIFESP; IVARNE LUIS DOS SANTOS TERSARIOL -
UNIFESP
Background: Heparin is a well-known anticoagulant drug widely used in Medicine.
However, the major clinical complication of heparin anticoagulant therapy is
bleeding. It has been suggested that heparin can produce intracranial hemorrhage
dependent of MMP-9 activity.
Methods: Bleeding time and bleeding flow - Briefly, a scarification is made with a
razor blade in the terminal part of a rat tail which is then immersed in a small test
tube containing 1 ml of a buffered isotonic solution to be tested held at 37ºC. The
bleeding from the vessels is observed with a dissecting microscope. The blood flow
was expressed as the ratio of mg of blood protein/minute oozed from the wound
treated with the compound and the amount of mg of blood protein/minute oozed
from the controls.
Results: Heparin (10-100 µM) was able to disrupt the normal vascular hemostatic
mechanism promoting hemorrhage. In order to establish that the heparin was
producing the bleeding by excessive activation of MMPs we have studied the
reversal of the antihemostatic effect of heparin by minocycline a potent inhibitor of
MMPs activity. Minocycline (10-100 µM) significantly reduced heparin-induced
hemorrhage in the scarified rat tail.
Conclusion: Our data strongly suggest that the hemorrhagic activity of heparin is
related to the excessive activation of MMPs in vascular system. The finding that
minocycline can neutralize the antihemostatic activity of heparin, make it a good
candidate as a therapeutic agent for the control of eventual hemorrhagic episodes
of patients under heparin treatment.

30. IMPAIRED B-ADRENERGIC RESPONSE TO ISOPROTERENOL IN CIRRHOTIC WISTAR
RATS
EDUARDO KAISER URURAHY NUNES FONSECA (ESCOLA PAULISTA DE
MEDICINA - UNIFESP - BRASIL)/AUTOR PRINCIPAL /APRESENTADOR
ELAINE DOS SANTOS DAMÁSIO (ESCOLA PAULISTA DE MEDICINA - UNIFESP –
BRASIL); HEDER FRANK GIANOTTO ESTRELA (ESCOLA PAULISTA DE
MEDICINA - UNIFESP – BRASIL); CÁSSIA DE TOLEDO BERGAMASCHI (ESCOLA
PAULISTA DE MEDICINA - UNIFESP – BRASIL); RUY RIBEIRO DE CAMPOS JR
(ESCOLA PAULISTA DE MEDICINA - UNIFESP - BRASIL)
The development of the hepatic cirrhosis leads to many pathologic chances in the
majority of the organic systems, including the cardiac system. These changes are
grouped together and named as Cirrhotic Cardiomiopathy, that includes a global
elevation in the basal cardiac output, which is not sustained in physical exercises
nor other activities that demand a physiological answer of increase in the cardiac
output that would be expected in non-pathological conditions. We aimed to
understand if the capacity of the cirrhotic cardiac muscle to respond, in vivo, to the
adrenergic stimuli is impaired by the cirrhosis, what was evaluated by the
administration of Isoproterenol, a potent agonist to receptors. We used the cirrhotic
model by common bile duct ligation (CBDL) in Wistar rats (200g) to these
experiments. In the fourth week after the CBDL, with the cirrhosis well-established,
the animals were submitted to a catheterism of the femoral artery and vein, to
direct registration of blood pressure, heart rate and drugs infusion, respectively. In
the vein, we administrated 3 doses of the Isoproterenol, in the following doses
(0,001µg/kg; 0,01 µg/kg e 1µg/kg), with the animals waken. After statistical
analysis of the data, we noticed that the cirrhotic animals, in basal conditions, had
an lower blood pressure (control (CO):108±2 and cirrhotic(CR):95±2mmHg, n=6)
and a higher heart rate (CO:352±10 and CR:396±13bpm, n=9) as well as an increase
in the hepatic enzymes TGO (CO: 197.5 ± 23.45 and CR: 566.3 ± 96.76 U/L, n=4) and
TGP (CO: 59.48 ± 5.570 and CR: 209.6 ± 43.92 U/L n=4). After the drug infusion,
there were also a statistically significant difference in the response between the
cirrhotic and the control to all the three doses of Isoproterenol: the increase of the
heart rate in CR was 2,4 times smaller that the CO in the smaller dose (0,001µg/kg) ;
was 3,6 times smaller for the intermediated dose (0,01µg/kg) ; and was 3 times
smaller for the higher dose (0,1µg/kg). We concluded that there is an important
impairment in the &#946;-adrenergic sensibility in the heart of the cirrhotic rats in
the fourth week past the cirrhosis induction surgery. Such finding can be seen as a
possible explanation to the heart failure that appear in cirrhotic man when they
undergo physical exercises or other conditions that require a bigger cardiac
demand to increase and sustain the cardiac output, explaining one of the most
important clinical impairments of the Cirrhotic Cardiomiopathy.

31. THE BEHAVIOR STUDY OF SERUM LEVELS OF SOLUBLE-FAS, ERYTHROPOIETIN,
INFLAMMATORY CYTOKINES AND ANEMIA IN CRITICALLY ILL PATIENTS WITH
ACUTE KIDNEY INJURY.
ILANA LEVY KORKES - ESCOLA PAULISTA DE MEDICINA
Background: Anemia is a problem that usually complicates critically ill patients. Serum
soluble-Fas (sFas) levels are associated with anemia in chronic kidney disease (CKD)
patients. Therefore, it is possible that sFas levels are also associated with anemia in
acute kidney injury (AKI) patients under inflammatory effects during hemodiafiltration.
Objectives: To compare hemoglobin (Hgb) concentration and serum levels of sFas,
erythropoietin (Epo), IL-6, TNF-&#61537; and IL-10 among critically ill patients with
and without AKI, CKD- hemodialysis patients and healthy volunteers. Investigate the
relationship between hemoglobin concentration, serum levels of sFas, Epo and
inflammatory cytokines in AKI patients in hemodiaflitration during 24hours.
Methodology: We studied critically ill patients with AKI in continuous venovenous
hemodiafiltration (AKI group; n=39), critically ill patients without AKI (non-AKI group;
n=17), CKD-hemodialysis patients (CKD group; n=20) and healthy volunteers (Healthy
group; n=18). Hematocrit and Hgb concentrations, iron status and serum levels of sFas,
Epo, TNF-a, IL-6 and IL-10 were analyzed in all groups at baseline. We also investigated
the correlation between these variables in AKI group after 24 hours of
hemodiafiltration.
Results: We observed that Hgb concentrations were lower in AKI group (p&lt;0,001).
We also saw that AKI patients had serum levels of IL-6, TNF-a, creatinine and ferritin
higher than non-AKI and Healthy groups (p&lt;0,001). Serum levels of sFas were higher
in AKI and CKD groups than in the other groups at baseline (p&lt;0,001).We found that
critically ill patients (AKI and non-AKI groups) had higher IL-10 serum levels than the
other groups and higher serum levels of Epo compared to Healthy group at baseline
(p&lt;0,001). After 24 hours of hemodiaflitration in AKI group, we observed that serum
levels of TNF-&#61537;&#61472;and Hgb concentration were lower and serum levels
of Epo, sFas and IL-6 were higher than before. Also, Hgb concentrations had negative
correlation with serum levels of sFas(r=-0.34; p= 0.01), TNF-a(r= -0.28; p=0.04) and IL-
6(r= -0.43; p=0.001). In multivariate analysis, after adjusting for markers of
inflammation, only serum sFas levels (p=0.02) correlated negatively with Hgb
concentration in the AKI group.
Conclusions: Our study shows that serum levels of Epo are higher in critically ill
patients and in CKD patients. At the same time, critically ill patients with AKI have
lower Hgb concentrations than the other studied groups and serum sFas levels, as well
as in CKD group, higher. These information show a possible inadequate response of
Epo. The negative independent correlation between serum sFas levels and Hgb
concentrations suggests that there is an association between serum sFas levels and
anemia in critically ill patients with AKI. In these cases, sFas could either be a cause
factor or a secondary marker of anemia.

33. EFFECTS OF PAPAVERINE ON CONTEXTUAL FEAR CONDITIONING DEFICIT
PRESENTED BY AN ANIMAL MODEL OF SCHIZOPHRENIA: THE SPONTANEOUSLY
HYPERTENSIVE RATS
BIANCA AVANSI CAMERINI - UNIVERSIDADE FEDERAL DE SAO PAULO; NATALIA CRISTINA ZANTA -
UNIVERSIDADE FEDERAL DE SAO PAULO; FILIPE M HUNGRIA - UNIVERSIDADE FEDERAL DE SAO PAULO;
CLAUDIO FONTES SOUZA - UNIVERSIDADE FEDERAL DE SAO PAULO; RODRIGO A BRESSAN -
UNIVERSIDADE FEDERAL DE SAO PAULO; VANESSA C ABILIO - UNIVERSIDADE FEDERAL DE SAO PAULO;
MARIANA BENDLIN CALZAVARA - UNIVERSIDADE FEDERAL DE SAO PAULO
Introduction: Typical antipsychotics are widely used to treat schizophrenia. These
drugs act by blocking dopaminergic D2 receptors in the striatum, therefore
increasing the cAMP level. Papaverine is known to inhibit phospodiesterase 10A
enzyme (PDE10A), which hydrolizes cAMP in the striatum. Hence, the inhibition of
PDE10A is involved with the increase of cAMP level, suggesting that papaverine
may produce antipsychotic effects. Recently, the Spontaneously Hypertensive Rats
(SHR) strain has been suggested as an animal model of schizophrenia. This strain
presents several behavioral characteristics of schizophrenia, including deficit in
contextual fear conditioning, deficit in social interaction and impaired prepulse
inhibition of startle (PPI). All of these deficits could be reversed by the
administration of antipsychotics. Considering the behavioral characteristics of SHR,
their adequate response to typical and atypical antipsychotics and the papaverine
molecular effects in the striatum, this pilot study aimed to investigate potential
antipsychotic effects of the papaverine on contextual fear conditioning deficit
presented by SHR strain.
Materials and methods: On the training session, the rats were individually placed in
a dark chamber with a grid floor. After 150 seconds, 0,4-mA foot shocks lasting 5
seconds were applied every 30 seconds for the subsequent 150 seconds. The test
session was performed 24 hours after training. Each animal was placed in the same
dark chamber, without receiving foot shocks. The freezing duration was quantified
during 5 minutes. The rats of different strains (i.e., Wistar and SHR, n=8 to 15 per
group) were treated during training session with saline as vehicle controls,
10mg/kg papaverine, 30mg/kg papaverine or 60mg/Kg papaverine. The session
was performed 30 minutes after the administration of the drug. Results: Two-way
ANOVA revealed a significant strain effect and treatment effect on contextual fear
conditioning. The SHR strain presented deficit on fear conditioning. Papaverine
increased the time of freezing on both strains.
Conclusion: This preliminary study showed that papaverine did improve the deficit
in emotional processing observed in SHR, suggesting its antipsychotical profile.

34. EFFECTS OF PAPAVERINE ON SOCIAL BEHAVIORS IN AN ANIMAL MODEL OF
SCHIZOPHRENIA: THE SPONTANEOUSLY HYPERTENSIVE RATS
NATÁLIA CRISTINA ZANTA - FEDERAL UNIVERSITY OF SAO PAULO; BIANCA AVANSI CAMERINI - FEDERAL
UNIVERSITY OF SAO PAULO; FILIPE M HUNGRIA - FEDERAL UNIVERSITY OF SAO PAULO; CLAUDIO
FONTES SOUZA - FEDERAL UNIVERSITY OF SAO PAULO; VANESSA C ABILIO - FEDERAL UNIVERSITY OF
SAO PAULO; RODRIGO A BRESSAN - FEDERAL UNIVERSITY OF SAO PAULO; MARIANA BENDLIN
CALZAVARA - FEDERAL UNIVERSITY OF SAO PAULO
Introduction: Typical antipsychotics are widely used to treat schizophrenia. These
drugs act by blocking dopaminergic D2 receptors in the striatum, therefore
increasing the cAMP level. Papaverine is known to inhibit phospodiesterase 10A
enzyme (PDE10A), which hydrolizes cAMP in the striatum. Hence, the inhibition of
PDE10A is involved with the increase of cAMP level, suggesting that papaverine
may produce antipsychotic effects. Recently, the Spontaneously Hypertensive Rats
(SHR) strain has been suggested as an animal model of schizophrenia. This strain
presents several behavioral characteristics of schizophrenia, including deficit in
contextual fear conditioning, deficit in social interaction and impaired prepulse
inhibition of startle (PPI). All of these deficits could be reversed by the
administration of antipsychotics. Considering the behavioral characteristics of SHR,
their adequate response to typical and atypical antipsychotics and the papaverine
molecular effects in the striatum, this study aimed to investigate potential
antipsychotic effects of the papaverine on the social interaction deficit presented by
SHR strain.
Materials and methods: Rats of different strains (i.e., Wistar and SHR, n=6-8 per
group) were treated with saline as vehicle controls, 10mg/kg papaverine or
30mg/kg papaverine 30 min prior to experimentation. Unfamiliar rats of the same
strain were paired and placed in an open-field for 10 min. During this time, social
behaviors, locomotion and rearing frequencies were scored. The social interaction
(SI) test was performed in an open-field (97cm in diameter and 32.5cm high, with
an open top and a floor divided into 19 similar parts) in a light room (25W).During
the test were scored parameters as locomotion, rearing frequency (the number of
times each animal stood on its hind legs) and passive social behaviors. This
experiment quantified for each rat the time spent engaged in active and social
behaviors.
Results: The SHR treated with saline presented impaired social interaction,
hyperlocomotion and increased rearing when compared to Wistar rats. The SHR
treated with 30mg/kg papaverine exhibited improvement on the social interaction,
attenuated hyperlocomotion and diminished rearing.
Conclusion: Our results demonstrated that papaverine is effective on the treatment
of positive (hyperlocomotion) and negative (social interaction deficit and increased
rearing) symptoms of schizophrenia observed in SHR. These results suggest that
papaverine present an atypical antipsychotic profile.

35. CHALLENGES IN SCREENING AND DEALING WITH ATTENTION DEFICIT
HYPERACTIVITY DISORDER ON CHILDREN IN PUBLIC SCHOOLS AT DISTRITO
FEDERAL
RAFAELA FERNANDES DANTAS - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; JULIANA NOGUEIRA
GARCIA - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; THATIANE DE SOUZA LEAO - ESCOLA SUPERIOR DE
CIENCIAS DA SAUDE; ANA LIDIA DE MELO ALCANTARA SILVA - ESCOLA SUPERIOR DE CIENCIAS DA
SAUDE; ATENA OLIVEIRA BENICIO - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; CLEIDIANE GOMES
VASCONCELOS - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; DIEGO SOCRATES MROZINSKI - ESCOLA
SUPERIOR DE CIENCIAS DA SAUDE; ANDRE FERREIRA AGUIAR - ESCOLA SUPERIOR DE CIENCIAS DA
SAUDE; RICARDO LUIZ RAMOS FILHO - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE
Introduction: The Attention Deficit Hyperactivity Disorder (ADHD) is the most
common childhood neurodevelopmental disorder. Its clinical presentation has
three different categories: inattention, hyperactivity and impulsiveness that are
manifested in at least in two different environments and cause functional
compromise. Considering that it is important to integrate health care services with
schools, a group of ten second year medical students from Escola Superior de
Ciências da Saúde visited two public schools in order to identify how much teachers
know about learning difficulties and to verify whether or not teachers are prepared
to deal and screen children with learning disorders.
Materials and Methods: Its a qualitative study based on the methodology of
problematizing using the Arch of Maguerez we developed this study making semi-
structured interviews with teachers from two public schools in Sobradinho II at
Distrito Federal in 2011. We used self made questionnaires that aimed to discover
how much teachers, educators and educational psychologists knew about child
learning disorders. The project was approved by the Ethics Committee of the
Secretaria de Saúde do Distrito Federal.
Results: Although half of the teachers said they knew what ADHD is, less than half of
them were formally trained to deal with children who suffer from ADHD. 85% of
them have at least one student diagnosed with ADHD. And 56,75 % believe its
appropriate to change the curriculum for these kids.
Conclusion: We noticed a low level of knowledge about learning disorders, mainly
ADHD, among the teachers even though most of them have at least one student who
suffers from this disorder and some others who suffer from different learning
difficulties. These teachers didnt go through training to deal with learning disorders
during graduation nor after it. &nbsp;Considering teachers needs, we prepared a
handbook about the most common learning disorders describing what really is
ADHD, ways to deal with diagnosed children and presenting some differential
diagnosis of ADHD.

37. SIMULATORS IN OBSTETRIC AND GINECOLOGIC PRACTICE: A COST-EFFECTIVE AND
REALISTIC MODEL FOR THE AMNIOCENTESIS TEACHING
KARL RICHARD BUSSE FILHO - UNIFESP; ANTÔNIO FERNANDES MORON - UNIFESP
Introduction: It is well know that maternal age is directly linked with fetal
malformations and with increase in chromosome abnormalities incidence. The
older the mother, the higher are the chances of congenital disturbances. The most
common way to get a fetal cell sample is by amniocentesis. Amniocentesis is a
diagnostic procedure that consists in the percutaneous trans abdominal puncture of
the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal
karyotype determination in order to diagnose abnormal fetal conditions. It is a very
efficient technique, but it is also invasive, and is also linked to a significative number
of complications. Depending on the case, amniocentesis can be very tricky to
perform, especially in the oligohydramnios affected patients. The technique
requires intense training and great ability, and these are neither easy to teach or to
learn. Some training models have been elaborated. They provide an environment
without risks, where errors are welcome, considered a part of the learn curve. Our
objective was to develop a simple and low-cost simulator, but at same time realistic
and capable of withstanding multiple procedures. As part of the task, we analysed
existing models proposed by other authors and developed our own model, which
incorporates their positive characters and brings creative solutions for their
problems.
Materials and Methods: The technique consists in three stages: (1) manufacturing of
the plaster molds; (2) manufacturing of the latex belly; and (3) setting the belly on
its support. We developed this technique by trial and error, and did many tests to
get it to its current format.
Results: In our tests the simulator worked perfectly as a amniocentesis training
device and for other ultrasonography procedures, such as the tridimensional study
of the fetus. We used water filled condoms as targets. The image was clear and
much better than expected. 4. Conclusion This device had a very low cost when
compared with other commercial simulators. The materials were chosen based on
their cost, easiness to be found, handled and based on their durability. Our
simulator was designed to withstand multiple punctures while maintaining its
integrity and realism. All this factors make maintenance extremely cheap and easy.
Another positive point is the possibility of using various belly sizes.

38. HUMANIZED CHILDBIRTH: A DIFFERENT FOCUS ON OBSTETRIC MEDICAL AREA
LÍVIA AMORIM - UNESP; LAURA NUNES LOPES - UNESP
Introduction: The central idea of Humanized Birth is to respect the pregnant
autonomy despite of the world tendency of mechanized and interventionist
medicine. The woman is called the birth owner, the obstetric is only a helper and
the birth is seen like a physiologic process which requires medical intervention in
only some restrict situations. This doctrine is based on scientific evidences and has
gained importance and visibility on the medical academic. The project is part of an
annual project between de Botucatu Medicine College (Faculdade de Medicina de
Botucatu- UNESP) and the Brazilian Health Ministry. The main objective is to search
how much the health professionals (doctors and nurses) in the basic attention know
about and apply this new obstetric doctrine on their assistance. This study gives a
parameter of the professionals actualization levels and shows how the future
mothers are been taken cared in the local health system. Materials and Methods:
The project involved a group [two tutors (Obstetrics and Gynecology University
teachers), thirteen medicine students and four preceptors] that met fortnightly in
the respective Department at the Medicine College. The study duration expected to
be one year, starting in April 2011. The group started studying many articles and
discussing about the theme. Then, a questionnaire with two descriptive asks was
elaborated to be applied to the health professionals. The questions covered the
knowledge about pregnant rights and the previous idea of humanized childbirth.
After the interviews, the group divided itself and organized four meetings with
those professionals to discuss the theme Humanized Childbirth based on their
answers at the questionnaire.
Results: The project initial hypothesis was confirmed: most of the interviewed
professionals have a superficial knowledge about the studied theme. These results
can undertake the attempt to improve the medical assistance for the pregnant and
show how much the government still has to invest on the professionals capacity and
on the society attention about this new obstetric tendency. The good new is that the
professionals who participated of the meeting really approved and seemed to be
interest to learn more about it. Conclusion: The Humanized Childbirth focus is on
the pregnant and her son, never on the obstetric doctor. The doctor is only an
adjuvant on the birth process. So the relevance of this project is to show the
professionals the necessity of a medical care quality, especially on this mother's
moment, and to promote much capacity as possible. The next step is to extend these
meetings for the others health professionals, besides doctors and nurses, like the
tutors were asked.

39. COMPARISON BETWEEN 2D-SONOGRAPHY AND MAGNETIC RESONANCE IMAGING
IN ASSESSMENT OF BRAIN AND SPINE PARAMETERS OF FETUSES WITH NEURAL
TUBE DEFECTS
MAYRA SATIKO LEMOS NAKANO - UNIFESP; EDWARD ARAUJO JUNIOR - UNIFESP
Objective: Compare the two dimension ultrasonography (2DUS) and magnetic
resonance imaging (MRI) in assesing the parameteres of the brain and spine of
fetuses with neural tube defects. Methods: We conducted a prospective cohort
study of 14 fetuses carrying neural tube defects (4 raquisquisis and 10
meningomyelocele). We assessed the size of the atrium of the lateral ventricle, the
shortening of the cerebellum, the involvement of the first vertebrae and the total
number of vertabrae affected by the herniation. 2DUS exams and MRI were
performed within a maximum of 7 days. For comparison and correlation
parameters of the two techniques, we used the paired t student test and correlation
coefficient (ICC), respectively. We also evaluated the correlation between
measurements by Pearson correlation test.
Results: There was no significant difference in any of the parameters evaluated by
means of the two techniques (p&lt;0.05), reliability, for example, between 2DUS and
MRI seems to be satisfactory for the lateral ventricle atrium widht and the level of
the first vertebra involved (ICC = 0.88 and 0.75, respectively). Measurements
obtained did not prove that there is a correlation between atrial width, level of
injury and fractional shortening of the cerebellum. Conclusions: In this study we
noticed that both 2DUS and MRI have no statistically significant differences in
measures to evaluate fetuses with neural tube defects. We also assess that there is
no correlation between atrial width, level of injury and fractional shortening of the
cerebellum in both 2DUS and MRI.

40. PREVALENCE OF PREGNANT ADOLESCENTS WOMEN ATTENDED AT UBS JARDIM
CUMBICA I - GUARULHOS BETWEEN OCTOBER 2009 AND 2010 AND THEIR
BIOPSYCHOSOCIAL IMPLICATIONS.
ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;
TALITA MACHADO BOULHOSA - UNICID
Introduction: According to the World Health Organization, adolescence is the period
of biopsychosocial development between 10 and 19 years. The increasing
proportion of sexually active adolescents is a public health problem because it
implies increasing the pregnancy rate in this age group and brings repercussions
for the mother and the condition of newborn infants. Among others, is associated
with increased incidence of cesarean sections, prematurity, intrauterine growth
restricted fetal distress and low birth weight.
Objective: Conducting an epidemiological study to determine the prevalence of
pregnant adolescents attended at Basic Health Unit (BHU) Guarulhos-SP and reflect
on their biopsychosocial implications. Methods: We analyzed medical records of 91
pregnant women in BHU Jardim Cumbica I - Guarulhos with the first prenatal visit
between October 2009 and October 2010. Data were entered and evaluated in an
Excel spreadsheet. Developed, then a descriptive analysis of the object.
Results: Of the 91 analyzed records, 29 were adolescents (32%), in agreement with
the literature and putting several issues about biopsychosocial implications.
Conclusion: Conclude by the importance of preventive and focused accompanying
to decrease risk of pregnancy among adolescents (especially in the poorest social
classes) and their fetuses. Accordingly, it is configured as a public health problem
and a relevant topic to be discussed by managers, health professionals and
researchers.

41. TIME TO DIAGNOSIS AND TREATMENT OF BREAST NEOPLASM IN SÃO PAULO
Tânia Topis – UNIFESP; Luiz Henrique Gebrim - UNIFESP
Introduction: Breast cancer is a public health problem in Brazil and worldwide. In
Brazil, breast neoplasm is the type that causes more deaths among women
according to data from Health Ministry. The aim of this study is to quantify the time
to diagnose and treat patients with breast cancer at the Hospital Pérola Byington in
São Paulo - SP - Brazil, the second largest Center of Reference for breast cancer,
which serves about 1000 new cases/year exclusively on public health, identifying
the stages of the process that are contributing to this fact.
Methods: This is a retrospective study. One hundred and eighty women who were
diagnosed with breast cancer were interviewed and their medical records were
consulted from September 2011 to April 2012 at Hospital Pérola Byington. We
evaluated the elapsed time in each of the actions as: Waiting time to look for health
service after symptoms appearance (Time A); waiting time for the first medical care
at UBS(B), time between the first consultation from the General Practioner and
mammography(C); time between the completion and outcome of
mammography(D); time between the scheduling of the ultrasound and its
completion(E); interval between the ultrasound and its outcome(F); time between
scheduling another subsidiary test and its completion(G); time between the
completion of the subsidiary test and its result(H), time to make an appointment at
the Reference Hospital(I); time between first consultation at reference hospital
until the scheduling of the biopsy(J); and the interval between the biopsy and its
outcome(K);time between biopsy outcome until start therapy (surgery or
chemotherapy)(L).
Results: Mean waiting time of symptomatic patients was 280,73 days, and median
was 188,5 days; Mean waiting time of asymptomatic patients (time between a
suspicious mammography result and the treatment) was 122 days, and median was
107 days; and, the largest contributor to this was "Time L". We can cite as good
result the median of "Time I" in both groups was 2 days, and, of "Time J" in
symptomatic patients was 1 day, and in asymptomatic patients was 0 days.
Conclusion: Average time to reach the Hospital Reference was excessive. We must
act so that the municipalities, responsible for primary care, enable physicians and
nursing staff to triage patients, care of patients with medium complexity because
80% of referrals are benign pathology. The time for diagnosis in the Hospital of
Reference was shorter than the average of three months of others Reference Public
Hospitals. "Time J" (1 day) is within international guidelines for biopsy (1-7 days),
but the end result of the test has an average of 30 days because of the necessity of
immunohistochemical technique. "Time L" had an average of 60 days (gold
standard of 15 to 30 days), because of difficulties in preoperative assessment,
patients with co-morbidities and the need to wait for the immunohistochemical
technique to start appropriate chemotherapy. The prospect for continuation of this
project is to increase the number of patients analyzed, thus achieving more reliable
data.

43. SYNCOPE DIAGNOSTIC IN CHILDHOOD AND ADOLESCENCE
FRANCISCO CAETANO SILVA JÚNIOR - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BH;
MARIANA PASA MORGAN - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BH; ANA CLÁUDIA
QUEIROZ GOMES - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BH
Introduction: Syncope is characterized for the sudden loss of consciousness
associated to the loss of tone and with fast recuperation. Even though it does not
have total physiology defined, is known that could be triggered by cardiology,
neurology or metabolic stimulus, knowing that the neurocardiogenic alternation
represents from 50 to 80% of total cases. It is estimated that up to 15% of children
will experience a syncopal episode before the end of adolescence. The diagnoses
must, in the very beginning, exclude the death potential conditions that require
hospitalization and treatment by a detailed anamneses and clinical exam, followed
by complementary exams like electrocardiogram at rest, HOLTER, ergometric exam,
electroencephalogram, tilt table testing, clinic pathologic exam, and others.
Objective: Accomplish a research in literature to indentify the principal etiological
factors and clinic signs in relation to syncope in children and adolescents.
Methodology: Accomplished researches in bases of electronic data using key words
(children syncope, syncope psychogenic and neurocardiogenic syncope) and their
fellow in Spanish and English language. Among the articles achieved, were selected
12 articles and 2 books for deeper analysis.
Discussion: the diagnostic of one sycope event begins with and detailed anamnese
realization, addressing three determined moments: before, during and after seizure.
The syncopal event is frequently jumbled with epileptically crisis, differing itself by
absence of tonic-clonic seizuresThe psychogenic syncope is related to high levels of
somatic symptoms, and to patients with more probability to present an syncopal
event are those who are affect by psychiatric disorders or that show rich pre-
syncopal symptoms. The cardiogenic syncope is specially related to events that
change directly the operation of cardiac bomb and can cause sudden death. The
principal causes are aortic stenosis, hypertrophic cardiomyopathy, coronary
malformation and primary arrhythmia. The pathophysiology of neurogenic syncope
is still not very known, however is known that few factors, since pain until keep
yourself into orthostatism, could generate the syncope due to exaggerate response
of autonomy nervous system. Occurs sympatic inhibition and parasympathetic
stimulation with resulting hypotension and bradycardia leading to cerebral
hypoperfusion that explain the loss of consciousness. Some authors believe that one
genetic component is responsible for alterations on regular system of arterial
pressure.
Conclusion: verified a large number of divergences in the literature specially related
to physiopathology of the three etiologic mechanisms of the syncope, proving the
need of realization for deeper studies about the subject. The correct approach of
syncope requires the diagnosis clarify for proper clarification of patients or family
members and the treatment institution when needed.

44. PROFILE OF PATIENTS WITH CHRONIC KIDNEY DISEASE AT PEDIATRIC
HEMODIALYSIS OF UNIFESP - ESCOLA PAULISTA DE MEDICINA
GABRIELLA MAFRA ELIA - UNIFESP
Introduction: Data regarding pediatric patients in hemodialysis is valuable to the
understanding of many questions such as health, nutritional and epidemiological
issues of this population and to allow the formulation of strategies to clinical
approach. Since there is few epidemiological study in this field in Brazilian
literature, it is very important to start research on this population, as it is the
intention of the present study.
Methods: This is an observational and descriptive study of the characteristics of 166
patients who have been in hemodialysis at the Pediatric Dialysis Unit at
Universidade Federal de São Paulo between august 1999 and august 2010. The
variables collected include: age at the beginning and at the end of treatment, sex,
weight at the beginning, attendance to school and possible evasion, time in
treatment, etiology of the Chronic Kidney Disease (CKD) that lead to hemodialysis,
last treatment before hemodialysis, number of sessions, number of sessions with
hypotension, vascular access used in the beginning and end, reason of exit, if return
to hemodialysis, time until the return, death and its causes and medication with
intravenous iron.
Results: In the period, 166 records were analyzed, which made up 156 patients,
since 10 left but came back. One hundred and six (63,86%) patients were male. The
weight average was 25,54 kg (range:56,6 to 3,925 kg). Ninety one (54,8%) patients
didn´t attend to school. Of the 75 (45,2%) patients who attended school, 13 (17,3%)
abandoned it during the treatment. The average age at the beginning of treatment
and time in treatment was 108,9 months (m) (range:216,4 to 3,1m) and 12,7 m
(range:71,3 to 0,1 m).The average number of sessions was 172,7 (range 932 to 3)
and the average number of the percentage of hypotension was 17,9 (range:80 to 0).
The most common vascular access in the entrance was Schilley's catheter with 61
(36,7%) patients and arterial-venous fistula in 41 (24,7%) patients. The major
reason for the exit was renal transplantation: 96 (57,9%) patients. The most
prevalent causes of CKD was congenital structural anomalies with 56 (33,7%)
patients and glomerular diseases with 55 (33,1%) patients. There were 20 deaths; 5
(25%) were due to sepsis, 4 (20%) to cerebral vascular accident and 5 (25%) to
unknown causes.
Conclusion: In the follow up of pediatric patients with CKD, hemodialysis was an
effective method and the average of hypotension found stayed bellow the one
described in the literature, which is around 30% of sessions.

45. ENDOSCOPIC FINDINGS IN 58 PEDIATRIC PATIENTS WITH MOUTH-BREATHING
HADELLE HABITZREUTER HASSMANN - FURB; BEATRIZ BRITTES KAMIENSKY - FURB; EDUARDA RAQUEL
PRZYGODA ALVES - FURB; PEDRO GEISEL SANTOS - FURB; JAN ALESSANDRO SOCHER - FURB
Introduction: Mouth-breathing is a common symptom in childhood and is
characterized by alterations in craniofacial and dental arch development, frequent
tiredness, daytime sleepness, adinamia, low apetite, nocturnal enuresis and even
learning and attention deficits. This symptom has several causes and it is therefore
necessary to clarify details about the clinical aspects according to its causes.
Objective: This study aims to raise the main endoscopic findings in pediatric
patients with mouth-breathing signs who were attended in an specialized
Otolaryngology service.
Material and methods: We surveyed medical records of 58 patients, from both
sexes, between 5 to 16 years old referred for Otolaryngology service by Odontology
and Orthodontic pediatric professionals for mouth-breathing evaluation. All the
patients were evaluated by sinonasal and pharyngolaryngeal endoscopic exams.
Results: The main findings were adenoid and/or tonsillar hypertrophy, rhinitis
signs (allergic or non-allergic), septal deviation, inferior turbinate hypertrophy and
high palate.
Conclusion: The causes of mouth-breathing are diverse and multifactorial and the
endoscopic exams are valuable on the evaluation of these cases for
complementation.

46. FUNCTIONAL OUTCOME OF MODERATELY PRETERM AND FULLTERM BORN SMALL
FOR GESTATIONAL AGE CHILDREN AT SCHOOL AGE
JOZIEN C TANIS - NEONATOLOGY, BEATRIX CHILDREN'S HOSPITAL, UNIVERSITY MEDICAL CENTER
GRONINGEN; KOENRAAD NJA VAN BRAECKEL - NEONATOLOGY, BEATRIX CHILDREN'S HOSPITAL,
UNIVERSITY MEDICAL CENTER GRONINGEN; JORIEN M KERSTJENS - NEONATOLOGY, BEATRIX
CHILDREN'S HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGEN; INGER FA BOCCA-TJEERTES -
NEONATOLOGY, BEATRIX CHILDREN'S HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGEN; SIJMEN A
REIJNEVELD - DEPARTMENT OF HEALTH SCIENCES, UNIVERSITY MEDICAL CENTER GRONINGEN; AREND
F BOS - NEONATOLOGY, BEATRIX CHILDREN'S HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGEN
Introduction: Being born small for gestational age (SGA) is one of the leading causes
of adverse perinatal outcome, i.e. high mortality and impaired short-term
development. Therefore, children born SGA are considered to be at risk for adverse
cognitive and motor outcomes. SGA birth can occur at all gestational ages and is
mostly seen in moderately preterm (MP) and fullterm (FT) born children. As yet,
their long-term functional outcome compared to appropriate for gestational age
(AGA) children is unclear.
Objective: To compare functional outcome at school age of moderately preterm and
fullterm children born small for gestational age with appropriate for gestational age
peers.
Materials and Methods: In this community based prospective study, we included
248 MP born children (32-36 weeks, n[SGA]=28) and 130 FT born children
(n[SGA]=11). SGA was defined as birth weight below the 10th percentile. At median
6.9 years, intelligence (IQ), verbal memory, attention, visuomotor integration (the
transformation of visual information into motor action), and motor skills were
assessed. Parental reports of executive functioning were collected. We determined
the differences in outcome between SGA and AGA children for the total group (MP
and FT), and for MP and FT children separately.
Results: Median birth weight was 1700 grams (range 705-2970) in SGA children
and 2630 grams (range 1330-1540) in controls, median gestational age was 35
weeks (range 32-41) in both groups. Of the SGA children, 61.5% was male versus
50.4% in controls (ns). Overall, functional outcome did not differ between SGA and
AGA children. An exception was visuomotor integration, on which SGA children had
significantly lower scores (P=0.046). No significant differences were found between
SGA MP and FT groups separately, compared to AGA MP and FT groups.
Conclusion: To our surprise, children born SGA had a comparable functional
outcome at school age as their AGA peers. An exception was visuomotor integration.
Our data suggest that being born SGA, whether moderately preterm or fullterm,
hardly affects functional outcome at school age.

47. EMERGENCY MEDICINE SESSIONS : UPDATED KNOWLEDGE TO MEDICAL STUDENTS
HUMBERTO BIA LIMA FORTE - FEDERAL UNIVERSITY OF CEARÁ; DANIEL MACHADO AMARAL - FEDERAL
UNIVERSITY OF CEARÁ; INGRID KELLEN SOUSA FREDERICO - FEDERAL UNIVERSITY OF CEARÁ; PAULO
MARCELO PONTES GOMES DE MATOS - FEDERAL UNIVERSITY OF CEARÁ; JOÃO HENRIQUE DE SOUZA
ANGELOTTO - FEDERAL UNIVERSITY OF CEARÁ; VIVIANE TEIXEIRA LOIOLA DE ALENCAR - FEDERAL
UNIVERSITY OF CEARÁ; BÁRBARA XIMENES BRAZ - FEDERAL UNIVERSITY OF CEARÁ; CLARA MOTA
RANDAL POMPEU - FEDERAL UNIVERSITY OF CEARÁ; CAIO MARTINS MENEZES NAVES MAYRINK -
FEDERAL UNIVERSITY OF CEARÁ; MARIANA LIMA VALE - FEDERAL UNIVERSITY OF CEARÁ
Introduction: The theoretical knowledge about Emergency Medicine is considered
as one of the most important and most difficult subjects for most of the medical
students and it is only approached in the University on classes in very advanced
semesters. Most of the students have a lot of difficulty to consolidate that
knowledge.
Materials ad Methods: the Emergency Sessions were organized by a group of
Medical Students, being offered to all the interested students, including the ones in
the internship, and professionals from the health field, promoting the scattering of
the latest information about the principal topics in Emergency Medicine. Three
sessions were planned to be performed during the year of 2011. The sessions
usually lasted one hour and a half being ministered by a Doctor known for his
primacy in the topic that would be addressed. The chosen themes were: the updates
in the advanced trauma life support(ATLS), acute abdomen and sepsis.
Results: The average public was 83 people, including students from almost every
semester in the medicine course. Beyond the recognition given to the students for
the sessions, also the professors gave a great value to the project.
Conclusion: the activity has assumed a very important place in the University,
always presenting a great attendance of the students. The intention to help the
students to overcome the difficulties of some important subjects in the graduation
process was accomplished and the group intend to continue and expand the activity
approaching in the year of 2012 the Internal Medicine theme.