No abstract

Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control.

Este estudo busca a construção de uma avaliação geográfica que denote a ocorrência ou não dos processos de diferenciação e (auto)segregação socioespacial, na escala da pequena cidade e das cidades locais. Reconhecemos a necessidade de uma análise multidimensional, tentando compreender suas particularidades e sua inserção nas redes regionais, sendo fundamental não desprezar as relações entre os citadinos e o espaço em suas práticas cotidianas, para compreender a produção do espaço urbano e as manifestações desses fenômenos, nesses centros. Trazemos assim, um estudo de caso para o município de Paulicéia/SP, com uma população de 6.339 habitantes (IBGE, 2010). Por meio da aplicação de metodologias qualitativas, evidenciamos nas análises a manifestações dos processos de diferenciação e segregação socioespacial na cidade.Palavras-chaves: práticas socioespaciais, diferenciação, segregação socioespacial, cidades pequenas, Paulicéia/SP.

No abstract

The primitive neuroectodermal tumors (PNETs) produce metastases in the basicranial axis. Extracranial metastases are infrequent and occur by dissemination through the cerebrospinal fluid (CSP). Sixty two cases of peritoneal carcinomatosis have been reported to date as due to a ventriculo-peritoneal shunt (VPS), four of them by pineoblastoma. We present the case of a pineoblastoma showing this extremely rare evolution and its response to platinum compounds and taxanes. We reviewed the literature which relates to this neoplasm and its treatment.