tag:blogger.com,1999:blog-38614376408035348452024-03-13T06:56:11.474+01:00Nós sustentamos a ciência, e ela a nósNa qualidade de médico estagiário, não podia deixar de dar o meu contributo a saúde da comunidade, e das pessoas em particular. Este blog vem então de forma humilde trazer alguns artigos que poderão esclarecer, instruir e discutir sobre os varios temas de saúde, particularmente a saúde preventiva.Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-3861437640803534845.post-58301787703365629502008-12-13T23:59:00.006+01:002008-12-14T01:52:58.511+01:00OCLUSÃO INTESTINAL<p class="MsoNormal" align="center" style="text-align: justify;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">C</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">onc</span></span></span></span></span><span class="Apple-style-span" style=""><span style=" ;"><span class="Apple-style-span" style=" "><span class="Apple-style-span" style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">eito</span></span></span></span></span><span class="Apple-style-span" style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">:</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Obstrução intestinal é a paragem completa e persistente do trânsito do conteúdo intestinal (sólido líquido ou gasoso) num segmento do intestino.</span></span></span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p> <p class="notacentro" style="text-align:justify"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Na literatura e na prática clínica usam-se como sinónimos os termos oclusão e obstrução. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="text-align:justify"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A obstrução intestinal representa, sempre, uma situação grave que requer uma atitude terapêutica urgente, constituída por reanimação médica e, muitas vezes, um acto cirúrgico como o objectivo de remover ou contornar um obstáculo.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="text-align:justify"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A caracterização clínica de um doente com obstrução intestinal inclui várias etapas como:</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">a)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Diagnosticar</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">b)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Localizar o nível de obstrução</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">c)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Precisar a etiologia</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">d)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Determinar o tempo de evolução</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">e)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Considerar os factores idade e sexo</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="margin-left:36.0pt;text-align:justify;text-indent: -18.0pt;mso-list:l8 level1 lfo9;tab-stops:list 36.0pt"><span style="mso-fareast-mso-bidi-font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">f)</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Adoptar para cada caso o tratamento adequado</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="notacentro" style="text-align:justify"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ETIOLOGIA E PATOGÉNESE</span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Classificação das Oclusões Intestinais</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><u><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quanto a Patogenia</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></u></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">1.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Mecânica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Simples</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Complicada (estrangulamento)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Em ansa fechada)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Funcional ou Neurogénica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Paralítica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Espástica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><u><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quanto a Localização</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></u></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">1.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Intestino delgado (70% dos casos)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Muito alta (duodenal)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Alta (jejunal)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Baixa (ileal)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Intestino grosso (30% dos casos)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Válvula ileocecal continente</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=""><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Válvula ileocecal incontinente</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="secartigo" style="text-align: justify;"><u><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quanto a Clínica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></u></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">1.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Aguda</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Sub-aguda</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">3.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Crónica</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">4.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Intermitente</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">5.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Completa</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 18pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">6.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Incompleta ou sub-oclusão</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A obstrução intestinal pode apresentar-se sob duas formas:</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">1.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Oclusão intestinal de causa mecânica: quando existe uma obstrução mecânica do lúmen intestinal;</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi- font-weight:normal;mso-bidi-font-weight:bold"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Oclusão intestinal de causa não mecânica: nestes casos existe paralisia do músculo da parede intestinal. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="secartigo"></p><p class="secartigo" style="text-align: justify;"><span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Principais Causas Mecânicas </span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As principais causas para a ocorrência de obstrução intestinal são: </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">1.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Aderências/bridas (principalmente em pessoas que já sofreram cirurgia abdominal)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Inflamações (peritonite, doença de Crohn)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">3.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Tumores</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">4.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Invaginação</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">5.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Volvulo/torção de alça</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">6.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Cálculo biliar (íleo biliar)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">7.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Bezoar (corpos estranhos)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">8.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Pós-cirurgias (complicações)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">9.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Vermes (ascaris)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">10.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Hérnias abdominais (internas e externas)</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">11.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Diverticulite</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">12.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Enterite por radiação</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">13.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Traumatismos</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" mso-fareast-mso-bidi-;font-family:Verdana;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">14.</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Íleo espástico</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo"></p><div style="text-align: justify;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><span><div style="text-align: justify;"><span class="Apple-style-span" style=" ;font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> Outras Causas Não Mecânicas</span></span><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div></span><p></p><p></p> <ol style="margin-top:0cm" start="1" type="1"> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Íleo paralítico (adinámico) que tem origem em diversas causas clínicas</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Isquemia mesentérica aguda</span></span></span></span><span style=" Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Distúrbios metabólicos</span></span></span></span><span style=" Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Intoxicação por chumbo (saturnismo)</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> </ol> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">DIAGNÓSTICO</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><span></span></span></span></span></span></o:p></span></p> <p class="secartigo"></p><p class="secartigo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quadro Clínico da Obstrução Intestinal </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A característica inicial de uma obstrução intestinal é a distensão do abdômen provocada pelo acúmulo de ar deglutido (vários litros diários), alimentos e secreções do aparelho digestivo - constituídas por saliva, sucos gástricos, biliares, pancreáticos e intestinais -, que podem chegar de seis a oito litros diários. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Portanto, o conjunto de alimentos, ar deglutido e secreções, ao não ser absorvido nas últimas porções do intestino, não conseguirá fazer o trânsito intestinal normal e, conseqüentemente, irá dilatar o intestino, provocando todo o quadro dramático de abdômen agudo, conhecido como obstrução intestinal. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p><p></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Este quadro pode ser repentino ou insidioso, dependendo principalmente: </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">da causa que o provocou</span></span></span></span><span style=" Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">se a luz do intestino fechou total ou parcialmente</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;mso-list:l10 level1 lfo3; tab-stops:list 36.0pt"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">se ocorreu repentinamente – casos de torção de alça, também chamados de volvulo ou casos de hérnia estrangulada – ou se ocorreu paulatinamente, como nos casos de aderências pós-operatórias ou devido a tumores </span></span></span></span></li></ul> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">se a dificuldade do fluxo não se deu por uma oclusão, como no íleo adinâmico.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> </ul> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">DIAGNÓSTICO DIFERENCIAL</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O diagnóstico diferencial da obstrução intestinal, apesar de ser complexo e multidisciplinar, é relativamente fácil para um médico experiente em abdômen agudo, pelas características próprias da luta da alça contra o obstáculo.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">É importante agir antes de aparecerem os vômitos fecalóides, os quais são os sinais de obstrução em alça intestinal baixa (distante do estômago).</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Com um simples estetoscópio usado no exame abdominal o médico pode ouvir ao mesmo tempo a queixa do paciente pela dor em cólica (dor intensa, tipo cãibra) e o som característico - de borborigmos, ronco do rolamento de líquidos-, o que a torna diferente das cólicas biliares e renais, nas quais não está presente o som inconfundível de luta da alça.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Inicialmente, deve ser excluído o quadro característico das cólicas menstruais, a possibilidade de gravidez ectópica, abortamento iminente e assim por diante. Esses dados devem ser ponderados também no exame radiológico.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As infecções agudas do intestino, onde também estão presentes as cólicas, não se acompanham de intensa distensão abdominal, geralmente com diarréia. Mesmo nas obstruções parciais, quando pode haver eliminação de fezes e gases, as alças intestinais estão distendidas muito acima do normal pelo acúmulo hidroaéreo.</span></span></span></span><span style=" Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quando a obstrução não é ocasionada por um agente mecânico, como no enfarte da artéria mesentérica (artéria que irriga o intestino), apesar da distensão abdominal, no achado clínico, não estarão presentes ao exame as cólicas e rolamentos na luz intestinal - é o chamado íleo paralítico ou adinâmico. Esta situação faz-se acompanhar de um quadro geral muito grave pelo sofrimento vascular.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Existe uma outra situação de íleo paralítico, raríssima, ocasionada por um distúrbio metabólico em conseqüência da falta de potássio.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Existem situações que fazem parte do diagnóstico diferencial. Por exemplo, o enfarte do miocárdio, a pancreatite aguda e o herpes zoster, com fortes dores abdominais e gás nos cólons, mas onde não existem os ruídos hidroaéreos característicos da luta intestinal contra o obstáculo. Exames, sintomas e sinais fazem o diagnóstico da causa e orientam seu tratamento clínico.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Quando o quadro obstrutivo mecânico provoca sofrimento vascular, como nos casos de volvulo (torção de alça) ou hérnia estrangulada, o estado geral do paciente se agrava rapidamente.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Na obstrução intestinal existe uma enorme desidratação endógena (interna) pelo acúmulo de líquidos no intestino.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A obstrução intestinal pode acontecer em qualquer sexo e idade. A mortalidade pode variar de </span></span></span><st1:metricconverter productid="2 a" st="on"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">2 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> 25% e se encontra relacionada com a demora na desobstrução.</span></span></span></span><span style="Verdana","sans-serif""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As obstruções parciais nos permitem avaliar com mais tempo a melhor orientação a tomar. Estes quadros representam mais de 50% das obstruções e a maioria pode ser resolvida sem intervenção cirúrgica. Outros quadros nos permitem colocar o paciente em melhores condições clínicas para uma intervenção com menor risco cirúrgico.</span></span></span></span></li></ul> <p class="seccorpo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p><p class="seccorpo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Portanto, um médico com ouvido experiente e exames adequados pode fazer o diagnóstico diferencial. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O exame clínico é imperativo – os exames apenas confirmam o diagnóstico.</span></span></span></span></p><p class="seccorpo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">EXAMES AUXILIARES DE DIAGNÓSTICO</span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgckmY0NdgxDHJgEPDNoKo0Rg-DwPfvYs7nLppOpwICFSs14IF71yND8yEeX2kCgoHtTNHwOcyZ1SaAiDD5RRWoBANmNOqLVf8UB78I9d8aTh5zpPkvojOO5UoP8pQmYpZm0rbqe5WDlrI/s1600-h/Imagem27.jpg"><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgckmY0NdgxDHJgEPDNoKo0Rg-DwPfvYs7nLppOpwICFSs14IF71yND8yEeX2kCgoHtTNHwOcyZ1SaAiDD5RRWoBANmNOqLVf8UB78I9d8aTh5zpPkvojOO5UoP8pQmYpZm0rbqe5WDlrI/s320/Imagem27.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5279423216888047554" style="text-align: justify;float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 240px; height: 320px; " /></a><span class="Apple-style-span" style="font-size:medium;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div></span><p class="secartigo"></p><p class="secartigo" style="text-align: justify;"><span><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="secartigo" style="text-align: justify;"><span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Exames de RAIOS-X </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Estes exames podem ser</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">executados em um hospital apropriado ou mesmo em um serviço mais simples, por um técnico treinado, os quais são interpretados pelo médico na ausência de um radiologista. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Foi provado cientificamente que praticamente todo ar no intestino delgado é simplesmente ar deglutido. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A ação de bactérias sobre alimentos não digeridos forma o gás do intestino grosso. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Em poucas horas após uma obstrução, já temos ar (sombra) suficiente para visualizar nos raios-X. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O exame que confirma o diagnóstico clínico é os </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">raios-X simples de abdômen</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">, com o paciente em posição vertical (em pé). </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Nesta posição, podemos identificar os níveis de líquidos (hidroaéreos), os quais são facilmente visualizados. Ao interpretar a localização dos níveis dos líquidos abaixo das sombras podemos obter conclusões e identificar a região da obstrução, já que as alças que estiverem acima estarão dilatadas, cheias de líquidos e gases. As que estiverem abaixo da obstrução estarão murchas. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Como os intestinos, jejuno, íleo e cólons têm suas características morfológicas diferenciadas, o médico experiente observa que os gases acumulados desenharam as paredes destes órgãos. Com estes sinais, ele pode determinar a provável localização da obstrução, por exemplo, se a oclusão é alta ou baixa. Serve também para orientar se a oclusão é total ou parcial. Na obstrução total, há ausência de ar no cólon e reto.Níveis líquidos na mesma alça, em alturas diferentes, demonstram obstrução mecânica (luta da alça). Quando esses níveis estão na mesma altura, indicam adinamia ou seja, íleo paralítico. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Exames de </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ultrasom (ecografia) e ressonância magnética</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> devem ser usados nos casos de dúvida da interpretação da radiografia simples de abdômen. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Em nossa experiência clinica, tivemos a oportunidade de descrever um sinal de oclusão total, ao qual denominamos de </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">“Sinal do Colar”</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">, com a simples verificação de pequenas quantidades de gás residual em alças murchas (pós-obstrução), com forma de pérolas. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Sempre deve ser excluída a possibilidade de gás extra-intestinal por perfuração de víscera oca (estômago e intestino). </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Essa exclusão é realizada no exame de raios-X. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Coloca-se o paciente deitado de lado (decúbito lateral) e faz-se a radiografia simples do abdômen com raios horizontais. Se houver, mesmo que seja uma pequena quantidade de gás na cavidade abdominal, o gás tenderá a subir e desenhar com uma sombra nítida a parte superior e lateral do abdômen, entre a parede abdominal e a membrana que envolve as vísceras (peritônio). Isso é ar fora das vísceras e a conclusão lógica é de que existe uma perfuração que pode acontecer, por exemplo, com uma úlcera perfurada que resulte em peritonite. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O uso de contrastes – Bário – além de produzir resultados discutíveis, atrapalha a interpretação dos níveis hidroaéreos, sendo que o paciente, principalmente aquele com obstrução alta, vomita o conteúdo e, no caso de paciente com obstrução baixa de intestino delgado, o contraste demora a chegar ao local. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O bário terá indicação por via baixa somente em alguns casos de obstrução do cólon e reto. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Combater a demora é o nosso principal objetivo, portanto, na nossa experiência, o uso do bário só trouxe dificuldades para o diagnóstico emergencial. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Ao mesmo tempo em que se confirma o diagnóstico, coloca-se o paciente em condições clínicas:</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">com sonda nasogástrica para descompressão da parte alta do tubo digestivo</span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align: justify;"><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">com adequada compensação do desequilíbrio hidroeletrolítico.</span></span></span></span><span style=""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></li> </ul> <p class="MsoNormal" style="text-align: justify;"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Com nossa experiência e através de uma pesquisa recente na literatura, entendemos que existe lugar para o uso de sondas intestinais longas, particularmente nas obstruções jejunais altas, quando o duodeno (1a porção do intestino) também sofre dilatação. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Como o duodeno possui uma irrigação singular na sua parede, essa situação provoca sofrimento, agravando o quadro clínico. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As novas técnicas de enteroscopia ajudam a colocar a sonda longa nas porções altas do intestino. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align: justify;"><span style=""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">TRATAMENTO</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A seguir, se a obstrução é total, procede-se à cirurgia, seja a tradicional ou por laparoscopia. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Não está bem claro qual o melhor método de intervenção, se laparoscopia ou laparotomia (cirurgia tradicional). </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Temos a impressão que, após uma triagem adequada e nas mãos de um cirurgião que conheça os benefícios e os limites da laparoscopia, esta seria a primeira opção de escolha na maioria das obstruções. Entretanto, sabemos que, em muitos casos, esta terá que ser convertida para uma cirurgia abdominal tradicional. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A cirurgia de paciente com obstrução intestinal, realizada por médico experiente em emergências, tem todas as condições de lograr grande êxito na solução desta ocorrência dramática. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As obstruções acompanhadas de peritonite sempre são tratadas, além da desobstrução, com grandes lavagens da cavidade abdominal para limpeza da infecção nesta cavidade. O peritônio (membrana que recobre todo o intestino) defende-se melhor quando atua contra o agente agressor com toda a sua superfície. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Sempre tivemos dúvidas em relação ao uso de drenos na cavidade abdominal após a ampla lavagem desta, em casos de peritonite. O benefício das drenagens era pequeno comparado com o grande risco de levar outra infecção de fora para dentro. Portanto, esta equação risco-benefício nos fazia recomendar o não uso de drenos. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Jamais verificamos uma perfuração dos intestinos exclusivamente por dilatação das alças intestinais.</span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">As obstruções intestinais com sofrimento vascular são encaminhadas com urgência para ressecção (retirada) intestinal da alça afetada</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo"></p><div style="text-align: justify;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><!--[if gte vml 1]><v:shapetype id="_x0000_t202" coordsize="21600,21600" spt="202" path="m,l,21600r21600,l21600,xe"> <v:stroke joinstyle="miter"> <v:path gradientshapeok="t" connecttype="rect"> </v:shapetype><v:shape id="_x0000_s1032" type="#_x0000_t202" style="'position:absolute;"> <v:textbox style="'mso-fit-shape-to-text:t'/"> </v:shape><![endif]--><span style="mso-ignore:vglayout"><div style="text-align: justify;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><span class="Apple-style-span" style="font-size:medium;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span><table cellpadding="0" cellspacing="0" align="left" style="text-align: justify;"><tbody> </tbody></table> </span><span style=" ;"><div style="text-align: justify;"><span class="Apple-style-span" style=" ;font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style=" ;font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Algumas Particularidades no Quadro de Obstrução Intestinal </span></span></span><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div></span><p></p><p class="secartigo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ÍLEO BILIAR</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O íleo biliar é uma pedra volumosa que provoca uma inflamação na parede da vesícula e atinge o órgão vizinho – o intestino. Com a progressão desta inflamação, ocorre a perfuração destas vísceras. A pedra ao progredir pela luz intestinal caminha até encontrar uma luz intestinal menor que seu tamanho ou vai arrolhar-se na válvula ileocecal (passagem do intestino delgado para o intestino grosso). Este processo provoca uma obstrução total ou intermitente.</span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ÍLEO POR BEZOAR</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Bezoar é um aglomerado constituído por cabelos ou vegetal, que se formam no estômago. Ao se tornarem volumosos, podem migrar pelo intestino e ocasionarem uma obstrução intestinal. Tivemos oportunidade de verificar esses tipos de ocorrência em 11 casos. Estes corpos estranhos podem ser retirados de modo fácil do intestino e, muitas vezes, com regozijo por serem mais comuns em pessoas idosas com suspeita de tumor maligno.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p><p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ÍLEO ESPÁSTICO</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Encontramos essa entidade curiosa por duas vezes: é um segmento do intestino de </span></span></span><st1:metricconverter productid="10 a" st="on"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">10 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span><st1:metricconverter productid="15 cm" st="on"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">15 cm</span></span></span></st1:metricconverter><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">, com contração permanente, em que a simples manobra de fazer passar os líquidos estagnados da pré-obstrução já desfaz a mesma.</span></span></span></span></p><p class="secartigo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">SATURNISMO</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Também faz parte da nossa experiência um quadro curioso de Saturnismo, ocasionado por ingestão de perdizes com chumbinhos de caça em um vidro de escabeche. Os sintomas lembram as cólicas da obstrução mecânica. O paciente apresentava ventre em tábua (defesa abdominal, com o abdômen duro à palpação), porém não havia oclusão intestinal.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p><p class="secartigo" style="text-align: justify;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><br /></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">ADERÊNCIAS</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Aderências são bridas ou membranas que se encontram, conforme estatísticas de respeitáveis centros médicos, entre </span></span></span><st1:metricconverter productid="50 a" st="on"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">50 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> 95% de vezes, em maior ou menor quantidade, após cirurgias abdominais realizadas por métodos tradicionais ou por laparoscopia. São responsáveis por grande número de obstruções intestinais e também por suas recidivas e não está claro qual dos dois métodos de intervenção (laparoscopia e cirurgia tradicional) provoca menor ocorrência de bridas.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Convém lembrar que, desfeita a obstrução, o intestino pós-oclusão deve ser cuidadosamente examinado, pois poderá haver mais de uma oclusão nas alças pós-obstrução e esse fato passar desapercebido durante o ato da intervenção. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Na tentativa de evitar recidivas e desfeita a obstrução, introduzimos a sistemática de fazer passar os líquidos estagnados na alça pré-obstrução para a alça pós-obstrução, com manuseio cuidadoso. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Como se Formam as Aderências? </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A trombina mais fibrinogênio, no líquido da cavidade abdominal, forma uma proteína chamada fibrina e é esta que constitui as membranas (chamadas bridas ou aderências), que se formam em até dois dias. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Na superfície da parede intestinal (serosa) age como se fosse uma cola que une as estruturas vizinhas, o que não deixa de ser uma cicatrização inconveniente. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="secartigo" style="text-align: justify;"><span style=";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Qual é a Nossa Expectativa? </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Esta “cola” junta as alças dilatadas (gordas), sem aglomerados, angulações, posições forçadas ou viciadas. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Na realidade, nós não estamos “prevenindo” novas aderências, elas é que irão se formar em superfícies com membranas mais extensas e largas, permitindo assim movimentação mais livre, quando as alças voltarem ao seu estado e tamanho normal. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Desta maneira, em vez de termos uma cicatrização que estreita, que encarcera ou aprisiona estas alças, teremos uma membrana (aderência) que será mais larga, mais frouxa, permitindo movimentos mais livres do intestino, evitando assim junções inadequadas e perigosas. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Em nossas verificações, tivemos a impressão de que houve menores recidivas obstrutivas por aderência, após a cirurgia e o uso desta sistemática. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Não houve, entretanto, oportunidade de fazer um acompanhamento com estudo controlado. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" align="left" style="text-align:left"></p><div style="text-align: justify;"><span class="Apple-style-span" style=" ;font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">O melhor tratamento será a conjugação de:</span></span><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><span style=" ;"><div style="text-align: justify;"><span class="Apple-style-span" style=" ;font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div></span><p></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" ;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">um clínico conservador que, preocupado com o estado geral do paciente, procure o melhor momento para uma cirurgia ou que consiga evitá-la.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;margin-left: 36pt; text-indent: -18pt; "><span style=" ;"><span style="mso-list:Ignore"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></span></span></span><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">um médico cirurgião destemido que também não queira perder a melhor oportunidade e diminuir o risco cirúrgico.</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">A maioria dos casos de oclusão parcial, bem avaliada, pode ser resolvida com tratamento clínico, com o uso de sondas para descompressão, principalmente se a causa é por aderência. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p> <p class="seccorpo" style="text-align: justify;"><span style=" ;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;">Finalizando, é importante destacar que o temido “nó nas tripas”, quando bem tratado, em condições adequadas, tem grandes probabilidades de solução. </span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></span></span></p><p></p><div> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="Verdana","sans-serif""><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-weight: bold;"> </span></span></span></o:p></span></p></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3861437640803534845.post-88331697373031645342008-11-25T22:59:00.004+01:002008-12-14T03:15:35.367+01:00LEPRA<p class="MsoNormal" align="center" style="text-align: left;"><span class="Apple-style-span" style="font-weight: bold; text-decoration: underline;"></span></p><p class="MsoNormal" align="center" style="text-align: left;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">INTRODUÇÃO</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><o:p><span style="text-decoration:none"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></u></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A Lepra foi descrita pela primeira vez</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">em textos</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">antigos do século VI</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">a.c. é uma doença crónica e</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">não fatal causada pelo </span></span></span><span class="mw-headline"><span style="mso-bidi-font-style:italic"><a href="http://pt.wikipedia.org/wiki/Mycobacterium" title="Mycobacterium"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Mycobacterium</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> leprae, cujas manifestações clínicas são basicamente</span></span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">restritas a pele,</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">aos nervos periféricos, tracto respiratório superior, olhos e testículos. O tropismo característico do </span></span></span><span class="mw-headline"><span style="mso-bidi-font-style:italic"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Mycobacterium</span></span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> pelos nervos periférico (dos grandes troncos neurais aos nervos cutâneos microscópicos) e certos estados reaccionais mediados imunologicamente são as principais causas de morbilidade na lepra.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A doença tem tendência a gerar,certas deformidades quando não tratada, consequentemente o reconhecimento da doença na maioria das civilizações, como sendo transmissível de uma pessoa para outra resultaram historicamente num estigma social profundo.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Actualmente com diagnostico precoce, a instituição de terapia adequada e eficaz, os pacientes podem viver de forma produtiva na comunidade e as deformidades e outras manifestações visíveis podem ser amplamente prevenidas.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Neste trabalho nos propusemos abordar este tema, dando maior ênfase ao nosso país, e procuraremos apresentar dados epidemiológicos, partindo como ponto de arranque o ano 2002, até 2007.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Julgamos não esgotar o assunto, com apresentação deste seminário, mas acreditamos ser útil para consolidação de tudo quanto soubemos sobre Lepra.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">CONCEITO</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A </span></span></span><span style="mso-bidi-font-weight: bold"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">lepra</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> ou </span></span></span><span style="mso-bidi-font-weight:bold"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">hanseníase, assim designada em homenagem a</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><a href="http://pt.wikipedia.org/wiki/Gerhard_Armauer_Hansen" title="Gerhard Armauer Hansen"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Gerhard Hansen</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, que identificou o agente da doença é uma doença infecciosa crónica causada pelo </span></span></span><a href="http://pt.wikipedia.org/wiki/Mycobacterium" title="Mycobacterium"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Mycobacterium</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> que afecta essencialmente os </span></span></span><a href="http://pt.wikipedia.org/wiki/Nervo" title="Nervo"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">nervos</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> e a </span></span></span><a href="http://pt.wikipedia.org/wiki/Pele" title="Pele"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">pele</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, podendo levar a danos severos.</span></span></span></span><u><span style="line-height:150%;Arial","sans-serif"font-family:";font-size:14.0pt;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></u><span style="font-family:"Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">EPIDEMIOLOGIA</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt"><span style="font-family:"Trebuchet MS","sans-serif"; mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A lepra atinge hoje em dia ainda mais de 11 milhões de pessoas em todo mundo, cerca de 700.000 casos novos por ano. Nos países desenvolvidos é quase inexistente, enquanto que </span></span></span><span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">nos países subdesenvolvidos e em desenvolvimento é endémica.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span style="Arial","sans-serif";font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A lepra continua a ser um problema de saúde pública em países de regiões tropicais e sub-tropicais.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span style="Arial","sans-serif";font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Em muitos estudos epidemiológicos, o sexo masculino é mais acometido do que o sexo feminino numa razão de 2:1 ou 3:1, mas isso pode representar um viés ao invés de uma maior susceptibilidade masculina. O clima também parece ser importante na determinação do padrão da doença. A lepra lepromatosa parece ser mais comum em climas temperados da Ásia, América do Sul, nordeste da Índia e Nepal, enquanto que a forma tuberculóide mostra-se mais frequente na África central tropical. A forma mais comum em Angola é a lepra lepromatosa.</span></span></span></span></p><p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">DISTRIBUIÇÁO NA AFRICA/ANGOLA</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-family:"Trebuchet MS","sans-serif"; mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A importância da lepra, no sentido da endemia, reduziu-se, mas o peso da doença manifesta-se ainda na sociedade, pelas pessoas portadoras de deficiências físicas (PPDs).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:36.0pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os países fronteiriços com Angola são de baixa endemicidade; apenas na República do Congo o numero de casos detectados tende a aumentar, enquanto nos outros países a tendência é para uma redução na detecção e na prevalência da lepra.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Em Angola ainda existem províncias onde os números de casos novos detectados são superiores a 80 por ano </span></span></span><span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">(Bengo, Kuando Kubango, Kwanza-Sul, Lunda Sul, Moxico, Namibe e Uíje)</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">. Estes vivem no seio das comunidades, onde existem ainda casos escondidos. Entre os 1,078 casos novos detectados em 2006, 8% chegaram com deformidades permanentes, em consequência de uma detecção tardia e apesar do conhecimento sobre a lepra estar a melhorar nos últimos anos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p><p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="Ss-titre" align="center" style="text-align:center;text-indent:35.4pt"><span style=";font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de Detecção por Província ANGOLA 2007</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" style="margin-left:70.8pt;text-indent:35.4pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:"Times New Roman"; mso-hansi-font-family:"Times New Roman";mso-ansi-language:FR-CH; mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type: symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="mso-tab-count: 1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family:"Arial","sans-serif"; mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Detecção</span></span></span><span style="mso-tab-count: 3"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">0 – 10 /100 000</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:70.8pt;text-indent:35.4pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:Arial;mso-hansi-font-family: Arial;mso-ansi-language:FR-CH;mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Detecção</span></span></span><span style="mso-tab-count:3"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">11 – 20 /100 000</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:70.8pt;text-indent:35.4pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:Arial;mso-hansi-font-family: Arial;mso-ansi-language:FR-CH;mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Detecção</span></span></span><span style="mso-tab-count:3"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">21 – 50 /100 000</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:70.8pt;text-indent:35.4pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:"Times New Roman"; mso-hansi-font-family:"Times New Roman";mso-ansi-language:FR-CH; mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type: symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="mso-tab-count: 1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de Detecção</span></span></span><span style="mso-tab-count:3"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">>51 /100 000habitantes</span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="Ss-titre" align="center" style="text-align:center"><span style="font-family:"Arial","sans-serif";mso-bidi-Courier New";font-style:normal;mso-bidi-font-style:italicfont-family:";font-size:12.0pt;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p><p class="Ss-titre" align="center" style="text-align:center"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:48px;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="Ss-titre" align="center" style="text-align:center"><span style=";font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de Prevalência por Município ANGOLA 2007</span></span></span></span></span></p> <p class="MsoNormal"><span lang="FR-CH" style="mso-ansi-language:FR-CH;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="margin-left:141.6pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:"Times New Roman";mso-hansi-font-family: "Times New Roman";mso-ansi-language:FR-CH;mso-char-type:symbol; mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Prevalência</span></span></span><span style="mso-tab-count:2"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">0 – 1.0</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:141.6pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:Arial;mso-hansi-font-family: Arial;mso-ansi-language:FR-CH;mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Prevalência</span></span></span><span style="mso-tab-count:2"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1.1 – 2.0</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:141.6pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:Arial;mso-hansi-font-family: Arial;mso-ansi-language:FR-CH;mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Prevalência</span></span></span><span style="mso-tab-count:2"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2.1 – 5.0</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:141.6pt"><span lang="FR-CH" style="font-family:Webdings;mso-ascii-font-family:Arial;mso-hansi-font-family: Arial;mso-ansi-language:FR-CH;mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span style="mso-char-type:symbol;mso-symbol-font-family:Webdings;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">g</span></span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa de</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-Times New Roman"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Prevalência</span></span></span><span style="mso-tab-count:2"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">> 5.1</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:141.6pt"><span style="font-family:"Arial","sans-serif"; mso-bidi-Times New Roman"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></p> <div align="center"> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="564" style="width:423.0pt;margin-left:3.5pt;border-collapse:collapse;mso-padding-alt: 0cm 3.5pt 0cm 3.5pt"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">ANOS</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Casos Novos</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Crianças</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Deform G2</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Curados</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:1;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2002</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">4272</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">12</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">13</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2420</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:2;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2003</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2933</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10,84</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">11,63</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2399</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:3;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2004</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2108</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10,86</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">9,58</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1720</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:4;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2005</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1877</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10,07</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">9,75</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1166</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:5;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2006</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1309</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">8,26</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">8,16</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">883</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:6;mso-yfti-lastrow:yes;height:14.05pt"> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2007</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1269</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="117" nowrap="" valign="bottom" style="width:87.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10,2</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="132" nowrap="" valign="bottom" style="width:99.1pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10,6</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="105" nowrap="" valign="bottom" style="width:78.75pt;padding:0cm 3.5pt 0cm 3.5pt; height:14.05pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">896</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> </tbody></table> </div> <p class="ListParagraphCxSpFirst" style="margin-left:0cm;mso-add-space:auto; text-align:justify"><span style="line-height:115%;Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-left:76.5pt;mso-add-space:auto"><span style="line-height: 115%;Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-left:76.5pt;mso-add-space:auto"><span style="line-height: 115%;Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">ETIOPATOGENIA</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O agente causador da Lepra é o </span></span></span></span><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c590;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Mycobacterium leprae</span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">. Trata-se de um parasita intracelular obrigatório álcool-ácido-resistente, delgado, rectilíneo ou ligeiramente curvo. Medindo de 3x0,5</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">μ</span></span></span></span><span style="font-family:"Arial","sans-serif"; mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> m. O microrganismo não pode ser cultivado in vitro. Tem afinidade pelos tecidos frios (pele, nervos periféricos, câmara anterior do olho, trato respiratório superior e testículos) poupando áreas mais quentes da pele (axila, virilha, couro cabeludo e linha média do dorso).</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os seres humanos constituem o principal reservatório de </span></span></span></span><span style="font-family:"Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span></span><span style="font-family:"Arial","sans-serif"; mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, os tatus silvestre (Lousiana), bem como macacos manbey e chimpazés são infectados naturalmente por </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">; os tatus podem desenvolver lesões lepromatosas.</span></span></span></span><u><span style=" line-height:150%;Arial","sans-serif"font-family:";font-size:14.0pt;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O modo de transmissão da </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> não está bem esclarecido; entretanto a transmissão interpessoal é regra. Pensa-se que a principal fonte de disseminação é representada por indivíduos infectados com lepra de tipo lepromatoso (Multibacilar), que espalham milhões de bacilos vivos por dia através das secreções nasais e das vias respiratórias superiores. As portas de entrada do </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> não estão bem definidas, podendo também incluir a ingestão de alimentos ou água, a inoculação dentro da pele (picadas, arranhaduras, pequenas feridas, tatuagens) ou a inalação para as vias nasais ou pulmões. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os bacilos podem permanecer vivos nas gotículas suspensas no ar e nas presentes no solo por mais de 24 horas e, excepcionalmente, até uma semana ou mais, especialmente em condições de clima quente e húmido e ao abrigo da luz solar. Isto favorece a entrada dos bacilos através das vias respiratórias e da pele lesada em indivíduos sãos, embora esta segunda via de transmissão não seja a mais importante.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A micobactéria parasita os </span></span></span><a href="http://pt.wikipedia.org/wiki/Macr%C3%B3fago" title="Macrófago"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">macrófagos</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> e as </span></span></span><a href="http://pt.wikipedia.org/wiki/C%C3%A9lula_de_Schwann" title="Célula de Schwann"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">células de Schwann</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> que formam a </span></span></span><a href="http://pt.wikipedia.org/wiki/Mielina" title="Mielina"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">mielina</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> dos </span></span></span><a href="http://pt.wikipedia.org/wiki/Nervo" title="Nervo"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">nervos</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> periféricos.</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A destruição da mielina leva à disfunção dos nervos.</span></span></span></span><span style="font-family:"Arial","sans-serif"; mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O </span></span></span><a href="http://pt.wikipedia.org/wiki/Sistema_imunit%C3%A1rio" title="Sistema imunitário"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">sistema imunitário</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> reage eficazmente às micobactérias pela formação de </span></span></span><a href="http://pt.wikipedia.org/wiki/Granuloma" title="Granuloma"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">granulomas</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">. O tipo de reacção imunitária ao </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> é extremamente importante na progressão da lepra. Esta bactéria sobrevive à </span></span></span><a href="http://pt.wikipedia.org/wiki/Fagocitose" title="Fagocitose"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">fagocitose</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> e multiplica-se inclusivamente dentro dos macrófagos. Se houver uma reacção </span></span></span><a href="http://pt.wikipedia.org/w/index.php?title=TH1&action=edit&redlink=1" title="TH1 (ainda não escrito)"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">T</span></span></span></span><sub><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">H</span></span></span></span></sub><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, citotóxica, com formação de granulomas sequestradores da bactéria e com destruição dos macrófagos infectados, a doença torna-se quase benigna e não é capaz de progredir - lepra tuberculóide. Se no entanto for activada uma resposta </span></span></span><a href="http://pt.wikipedia.org/w/index.php?title=TH2&action=edit&redlink=1" title="TH2 (ainda não escrito)"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">T</span></span></span></span><sub><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">H</span></span></span></span></sub><span class="Apple-style-span" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0);"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2</span></span></span></span></a><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, com produção de anticorpos, não há formação de granulomas e a bactéria dissemina-se, surgindo a lepra típica, ou lepra lepromatosa.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="font-family: "Arial","sans-serif";mso-bidi-font-family:MSTT31c56b;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Na pequena percentagem de pessoas que são susceptíveis à Lepra, após a infecção decorre um período assintomático de incubação, de duração prolongada e variável; considera-se que o período de incubação da Lepra (desde a infecção até ao aparecimento dos primeiros sinais clínicos) é em média de 5-7 anos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span style="Arial","sans-serif"; font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Como em outras doenças infecciosas, a conversão de infecção em doença depende de interacções entre factores individuais do hospedeiro, ambientais e do próprio </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:18.0pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif";font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Devido ao longo período de incubação, é menos frequente na infância. Contudo, em áreas mais endémicas, a exposição precoce, em focos domiciliares, aumenta a incidência de casos nessa faixa etária. Embora acometa ambos os sexos, observa-se predominância do sexo masculino, em uma relação de dois para um.</span></span></span></span></p><p class="MsoNormal" style="text-align:justify;text-indent:18.0pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" style="margin-left:38.25pt;text-indent:-20.25pt;line-height: 200%;mso-list:l5 level1 lfo9;tab-stops:list 38.25pt"><span style="line-height: 200%;Arial","sans-serif";mso-fareast-font-family:Arial;"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span></span><u><span style="line-height:200%;Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">MANIFESTAÇÕES CLÍNICAS E DIAGNOSTICO DIFERENCIAL</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></u></p> <p class="MsoNormal" style="line-height:200%"><u><span style="line-height:200%;Arial","sans-serif"font-family:";"><o:p><span style="text-decoration:none"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></o:p></span></u></p> <p class="MsoNormal" align="center" style="text-align:center;line-height:200%"><span style="line-height:200%;Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Classificação operacional (O.M.S.)</span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Para muitas doenças é importante ter um sistema de classificação. A sua importância é ainda maior para uma doença como a Lepra, que apresenta grandes mudanças nas suas manifestações clínicas e acentuadas diferenças na sua imunologia, histologia, evolução e epidemiologia.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A principal importância da classificação para a estratégia de controlo da Lepra, relaciona-se com: a escolha do regime quimioterápico apropriado ao tratamento; a identificação dos doentes infecciosos, de suma importância epidemiológica e que, portanto, devem ser o principal alvo da quimioterapia; a identificação dos doentes mais aptos a desenvolver complicações. </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span style="line-height:150%; Arial","sans-serif"font-family:";font-size:10.0pt;"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span style="mso-tab-count:1"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O pilar principal para a classificação da Lepra é a clínica e faz-se de acordo com</span></span></span></span><span style="line-height:150%;Arial","sans-serif"font-family:";font-size:10.0pt;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">o número e a morfologia das lesões cutâneas e as manifestações neurológicas</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">.</span></span></span></span><span style=" line-height:150%;Arial","sans-serif"font-family:";font-size:10.0pt;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Hoje, com uma finalidade eminentemente prático-operativa, (O.M.S.) os doen-</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">tes são classificados em dois grupos, Paucibacilares (PB) ou Multibacilares (MB), que estão relacionados com as suas características clínicas e bacteriológicas.</span></span></span></span></p><p class="MsoNormal" style="text-align:justify;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" align="center" style="text-align: left;text-indent: 35.45pt; line-height: 150%; "><span style="line-height:150%;Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra Paucibacilar (PB)</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">.</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os doentes têm um número relativamente baixo de bacilos (poucos bacilos = paucibacilar). Nestes, a resposta imunitária é boa, mas não completa; a defesa orgânica está alterada mas é ainda forte: por isso a doença é limitada.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Estão incluídos nesta classificação os casos antigos que foram diagnosticados, segundo a classificação de Ridley e Jopling, como Indeterminados (I), Tuberculóides (TT) e os.borderline. ou Dimorfos Tuberculóides (BT, DT) com baciloscopia negativa.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os nervos periféricos geralmente não estão comprometidos; contudo pode ser encontrado somente 1 nervo afectado.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Estes doentes muitas vezes podem desenvolver reacções de tipo I, com ou sem neurites. É esta a razão que provoca, com frequência e rapidez, o dano nervoso (às vezes irreversível) e as incapacidades.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align: left;text-indent: 35.4pt; "><span style=" Arial","sans-serif"font-family:";font-size:14.0pt;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span class="Apple-style-span" style=" line-height: 24px; font-size:16px;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra Multibacilar (MB)</span></span></span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">São doentes que têm um grande número de bacilos (muitos bacilos = multibacilar). A resposta imunitária é fraca ou está ausente: a doença é geralmente disseminada. Encontram-se bacilos em muitas ou em todas as áreas do corpo, inclusive no muco nasal.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A baciloscopia é geralmente positiva nas lesões.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os casos que clinicamente parecem paucibacilares, mas que têm baciloscopia positiva, são automaticamente casos multi-bacilares.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esta classificação inclui todos os casos classificados como dimorfos ou borderline. (BB), borderline lepromatosos (BL) e lepromatosos (LL), pela classificação de Ridley e Jopling, assim como quaisquer outros tipos com baciloscopia da pele positiva.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Existem lesões em número elevado e variadas, tais como manchas, placas, infiltrações e nódulos isoladas ou combinadas. Geralmente os bordos são mal definidos e a superfície é lisa.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Encontrar mais de 5 manchas indica Lepra Multibacilar; da mesma forma, a infiltração cutânea e os nódulos são característicos da Lepra Multibacilar.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os olhos, o nariz e ou os testículos podem estar também afectados.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os nervos atingidos podem ser numerosos e o dano manifesta-se tardiamente</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%;mso-layout-grid-align: none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">durante o decurso da doença. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Na fase precoce da doença, a sensibilidade nas lesões mantém-se, enquanto que na fase avançada se encontra diminuída ou ausente em grandes áreas do corpo, devido ao dano, tanto a nível dos troncos nervosos como das fibras nervosas cutâneas.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As lesões apresentam tendência à simetria.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">É a forma de Lepra mais contagiosa. Se não for tratada é uma grande fonte de contágio para a comunidade e provoca graves danos nervosos no próprio doente.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%;mso-layout-grid-align:none;text-autospace:none"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Podem aparecer complicações, as reacções, de que falaremos mais adiante.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A descrição profunda do espectro granulomatoso da lepra, foi feita por Ridley e seus colaboradores, baseando-se nas alterações clínicas e histológicas. Este espectro varia da alta para a baixa resistência. O espectro é o seguinte:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span style="mso-tab-count:5"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">TTp TTs ←BT ↔ BB ↔BL ↔LLs LLp</span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As formas TT e LL são clinicamente estáveis, mas entre estes pólos a atitude granulomatosa do hospedeiro pode variar, como indicado pelas setas. Os pacientes BT podem subir para a forma TT, tornando-se estáveis, mas os pacientes LLs não podem descer para a forma LLp nem estes últimos subir para a forma LLs. A patogénese do espectro granulomatoso é amplamente aceite como sendo mediado pela reacção imunológica do tipo IV, imunidade mediada por células ou pela hipersensibilidade do tipo retardado.</span></span></span></span></p><p class="MsoNormal" style="text-align:justify;line-height:150%"><span class="Apple-style-span" style="font-family:'Arial Narrow';"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Cinco tipos de anormalidades nervosas periféricas são comuns na lepra:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <ol style="margin-top:0cm" start="1" type="1"> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l2 level1 lfo6; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Dilatação do nervo</span></span></span></span><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, normalmente naqueles próximos da pele, como o grande auricular, ulnar, cutâneo radial, peroneal superficial, sural e tibial posterior;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l2 level1 lfo6; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Diminuição sensorial nas lesões cutâneas;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l2 level1 lfo6; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Paralisia do tronco nervoso</span></span></span></span><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, acompanhada ou não de sinais e sintomas de inflamação. É uma neuropatia silenciosa muitas vezes com perda motora e sensorial (fraqueza e/ou atrofia), e se de longa estadia, também pode ocorrer contractura;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l2 level1 lfo6; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Diminuição da sensibilidade em forma de meia-luva</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l2 level1 lfo6; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Anidrose nas palmas e plantas</span></span></span></span><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">, sugerindo envolvimento nervoso simpático.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> </ol> <p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os sinais que caracterizam clinicamente a doença são:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <ol style="margin-top:0cm" start="1" type="1"> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l7 level1 lfo7; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lesões da pele;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l7 level1 lfo7; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Perda de sensibilidade: nas lesões da pele, ou nas extremidades;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l7 level1 lfo7; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Engrossamento de alguns nervos periféricos.</span></span></span></span></li></ol> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O tipo, o número de lesões e a sua distribuição na pele, bem como as suas características morfológicas (bordos, superfície) variam de acordo com a resistência do organismo para com a </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Mycobacterium leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> (Ml).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A resistência condiciona também o número de bacilos que conseguem invadir o organismo (número relativamente pequeno de bacilos – paucibacilar, e número muito elevado de bacilos multibacilar.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As máculas (manchas) e as placas (lesões ligeiramente infiltradas) podem estar presentes em todas as formas de Lepra.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A Lepra num paciente com forte resistência imunitária, pobre em bacilos, caracteriza-se por lesões com distribuição assimétrica: máculas (manchas) ou placas que apresentam bordos bem definidos e superfície áspera ao tacto. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A Lepra num paciente com fraca resistência imunitária, caracteriza-se por lesões com distribuição simétrica: manchas ou placas com bordos mal definidos, lisas ao tacto.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra tuberculóide polar</span></span></span></span><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Nesta forma a imunidade é forte, manifestando-se com cura espontânea e ausência de diminuição para uma atitude de diminuição da resistência do hospedeiro. A primeira lesão cutânea é a placa, assumindo muitas vezes a forma anular secundária a propagação periférica e clareamento central. Tipicamente, a lesão é firmemente endurecida, elevada, eritematosa, escamosa, seca, sem folículos pilosos e hipopigmentada, mas com considerável variação encontrada. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O nervo sensorial vizinho, pode ou não estar dilatado, mas a própria lesão é caracteristicamente hiperestésica e anidrótica, com a lesão tendo como limite superior </span></span></span><st1:metricconverter productid="10 cm" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10 cm</span></span></span></st1:metricconverter><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> de diâmetro. As lesões normalmente são solitárias, principalmente naqueles pacientes que são TT novo, em contraste com aqueles que subiram a partir da forma BT, onde múltiplas lesões não mais que três, são encontradas. Histologicamente, as lesões novo são pequenos tubérculos com largo envolvimento linfocitário.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra borderline tuberculóide</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Nesta forma a resistência imunológica é forte o suficiente para deter a infecção, que é limitada e o crescimento bacilar retardado, mas a resposta do hospedeiro é insuficiente para auto-cura. Estes pacientes são um tanto instáveis, visto que a resistência pode aumentar para a forma TT ou diminuir para a forma BL.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As lesões primárias são placas e pápulas. Como na forma TT, a configuração anular é comum e ambos os bordos estão nitidamente delimitados, mas as lesões anulares ou as placas pode ter pápulas satélites a delimitar. A hipopigmentação pode ser notável nas pessoas de pele escura. Em contraste com a forma anterior, há menos ou ausência de descamação, menos eritema, menos dureza e menos elevação, mas as lesões podem tornar-se maiores. São comuns lesões múltiplas e assimétricas, mas lesões solitárias não são raras. Há diminuição da sensibilidade nas lesões e é comum a dilatação do tronco nervoso ou sua paralisia, normalmente assimétrica e afectando não mais que dois nervos.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Hostologicamente, o envolvimento linfocitário é menor, as células gigantes de Langhans são menos comuns ou estão ausentes e existe alguma exocitose focal. Se estiver presente a reacção de hipersensibilidade retardada deve ser suspeita.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra borderline</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">É o centro do espectro, sendo a área mais instável, onde os pacientes podem mudar rapidamente para um estado granulomatoso mais estável, com ou sem reacção clínica. São observadas na pele lesões anulares com as margens interna e externa bem delimitadas, placas com ilhas de pele clinicamente normal dentro da placa, dando um aspecto de queijo suíço ou de uma lesão dimórfica clássica. Devido à instabilidade esta forma é breve e estes pacientes raramente são vistos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra borderline lepromatosa</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A resistência está demasiado baixa para deter a proliferação bacilar, mas continua o suficiente para induzir a inflamação destrutiva tecidular, especialmente nos nervos. Esta forma é altamente variável na sua expressão clínica. Embora seja observado apenas num terço dos pacientes, a lesão dimórfica clássica é a mais característica, tendo uma configuração anular com o bordo externo mal delimitado e o interno bem delimitado.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Como dito geralmente, as lesões anulares e as placas, que são numerosas, são assimétricas, mas os nódulos, quando numerosos são simétricos. As paralisias nervosas são altamente prevalentes mas são variáveis em número, variando de nenhum a sérios défices, tanto motores como sensitivos, nas quatro extremidades. É característico o envolvimento simétrico dos nervos ulnar e mediano.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Histologicamente, uma resposta clássica é o infiltrado linfocitário denso confinado aos espaços ocupados pelos macrófagos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra lepromatosa</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A ausência de resposta imunitária mediada por células dirigida ao </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> uma replicação bacilar ilimitada e uma disseminação da doença multiorgânica. Uma infiltração dérmica difusa está sempre presente subclinicamente e na LL difusa não nodular, pode estar nitidamente presente pelo alargamento do lobo da orelha, alargamento da base do nariz, aumento fusiforme dos dedos que imita uma doença reumática. Nódulos mal definidos são as lesões mais comuns, normalmente acima de </span></span></span><st1:metricconverter productid="2 cm" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2 cm</span></span></span></st1:metricconverter><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> de diâmetro e estão simetricamente distribuídos. O fácies leonino resulta da conjunção das lesões nodulares.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A perda de cabelo é comum nas sobrancelhas, que pode progredir lateromedialmente (madarose) ou estar com lapsos, afectando as pestanas e as extremidades. O envolvimento do couro cabeludo é raro devido à alta temperatura cutânea. O envolvimento sensorial em forma de meia luva é comum e pode ser tão severo que leva a alterações tróficas debilitantes nas mãos e pés.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Histologicamente, as formas LLs e LLp apresentam algumas semelhanças:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <ol style="margin-top:0cm" start="1" type="1"> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As lesões nodulares apresentam abundantes macrófagos dérmicos, espumantes ou indeferenciados e um “salpico” de linfócitos;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Clinicamente, pele normal usualmente infiltrada;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Agregados “pseudofoliculares” densos de linfócitos podem ser de células B;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Bacilos nas células endoteliais e de Schwann são comuns;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Células plasmáticas e plasmócitos estão em constante crescimento;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l0 level1 lfo8; tab-stops:list 36.0pt"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Células gigantes adventícias/ estranhas podem ser encontradas nas lesões mais antigas.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> </ol> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif";mso-bidi-font-family:Arial;"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra indeterminada</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal"><span style="font-family:"Arial Narrow","sans-serif"; mso-bidi-font-family:Arial;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Clinicamente, a lesão indeterminada é uma mácula hipopigmentada, com ou sem défice sensorial associado na lesão ou na vizinhança, e os bacilos se encontrados estão presentes em pequenos números.</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">6.2. ESTADOS REACCIONAIS</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Eritema nodoso lepromatoso (ENL</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Doentes com</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">doença de lepra lepromatosa limítrofe (LLL) ou lepra lepromatosa( LL), mantém altos os níveis circulantes de anticorpos anti-</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. Leprae </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">e de antígenos, isto porque após quimioterapia ocorre libertação de antigenos solúveis no espaço extracelular. O ENL apresenta-se sob a forma de nódulos eritematosos subcutâneos dolorosos, que surgem difusamente e por vezes levam a necrose e supuração. Estes sintomas acompanham-se de febre e mal-estar. Esta sintomatologia é prolongada e pode estar associada a inflamação dos olhos, testículos, gânglios linfáticos, nervos e articulações.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <h2 style="text-indent:35.4pt;mso-layout-grid-align:auto;text-autospace:ideograph-numeric ideograph-other"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-style: italic;">Reacções de reversão</span></span></span></h2> <p class="MsoBodyText" style="text-indent:35.4pt;line-height:150%;mso-layout-grid-align: auto;text-autospace:ideograph-numeric ideograph-other"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Também pode ocorrer após quimioterapia que resulta tanto no aumento como na diminuição na IML local, acompanhada de eritema disseminado e endurecimento das lesões preexistentes, assim como o aparecimento de sintomas sistemicos (pirexia).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">6.3. ACHADOS FÍSICOS (GRAVIDEZ E HIV)</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p style="text-align:justify;text-indent:35.45pt;line-height:150%"><span lang="EN-US" style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Não existem problemas de transmissão da micobactéria da Lepra por via transplacentar, nem perigos de contaminação da criança no momento do parto. </span></span></span></span><span style="Arial","sans-serif";mso-ansi-language:PTfont-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">No entanto nem toda a classe médica concorda com isso, há relatos de</span></span></span></span><span style="mso-bidi- line-height:150%;Arial","sans-serif";mso-ansi-language:PTfont-family:";font-size:10.0pt;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span style="mso-bidi- line-height:150%;Arial","sans-serif";mso-ansi-language:PTfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">transmissão vertical da lepra durante a passagem pelo canal de parto quando em contacto com o muco cervical e em contacto com as lesões lepromatosas do endométrio e da placenta.</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p style="text-align:justify;text-indent:35.45pt;line-height:150%"><span style="Arial","sans-serif";mso-ansi-language:PTfont-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Existe porém alguma atenção que deve ser dada à mulher com Lepra durante e depois da gravidez. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p style="text-align:justify;text-indent:35.45pt;line-height:150%"><span lang="EN-US" style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Devido às mudanças no estado Imunológico provocadas pela gravidez (e talvez pela associação de outros factores concomitantes, como por ex. </span></span></span></span><span style="Arial","sans-serif"; mso-ansi-language:PTfont-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Infecções intercorrentes e desnutrição), a gravidez numa mulher com Lepra pode estar associadas algumas complicações ou agravamento do estado clínico com uma frequência bastante elevada (até 50% das mulheres). É também conhecida a associação da gravidez ao aparecimento, agravamento e recidivas da hanseníase bem como, a um aumento da frequência dos estados reacionais entre os quais, o </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">fenómeno de Lúcio</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> tambem chamado de </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">eritema necrosante</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="line-height: normal; font-size:48px;"></span></span></span></span></span></p><p style="text-align:justify;text-indent:35.45pt;line-height:150%"><span style="Arial","sans-serif";mso-ansi-language:PTfont-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">fenómeno de Lúcio foi descrito pela primeira vez por Lúcio e Alvarado, em 1852, como uma reacção necrosante ocorrendo na pele dos portadores da dita "lepra não nodular". Em 1948, zatapí e Zamora reconheceram como sendo o estado reacional daquela que denominaram "forma lepromatosa difusa pura e primitiva" da hanseníase, a qual é encontrada sobretudo no México e América Central, raramente ocorrendo em outros grupos étnicos. No Brasil, porém, o fenómeno de Lúcio tem sido observado em pacientes virchowianos ou próximos deste pólo, não se limitando à variedade difusa da hanseníase. Ocorre em doentes com infecção avançada sem tratamento específico adequado</span></span></span><sup><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></sup><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">ou precedendo o início deste.</span></span></span></span></p><p style="text-align:justify;text-indent:35.45pt;line-height:150%"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;mso-layout-grid-align: none;text-autospace:none"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra e HIV</span></span></span></p> <p class="MsoNormal" style="text-align:justify"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A seroprevalência do HIV em inquéritos conduzidos em vários países do mundo evidenciaram prevalências variáveis entre 0,29% no Rio de Janeiro e 33,3% na Zâmbia. Nos estudos publicados, não se encontraram diferenças estatisticamente significativas entre a seroprevalência de HIV nos doentes de Lepra e nos controlos sadios (dadores de sangue).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Não há evidência de que a infecção por HIV aumente o risco de contrair a Lepra. Não se encontrou diferença significativa de seroprevalência entre doentes Pauci e Multi-bacilares, com a excepção nos doentes do Uganda, onde a seroprevalência de HIV </span></span></span><st1:personname productid="em doentes MB" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">em doentes MB</span></span></span></st1:personname><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> era quase três vezes superior à dos doentes PB. Parece que a infecção por HIV não altera a proporção de PB/MB. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os aspectos anatomo-patológicos das lesões da pele e dos nervos são semelhantes nos doentes de lepra HIV+ e nos HIV ¾ . </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Precisam-se mais estudos que se relacionam com a incidência e o decurso das neurites nos doentes HIV+. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A resposta ao tratamento TMAA é igual nos doentes de Lepra HIV+ como nos HIV ¾ . </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Não há evidência de que a infecção por HIV possa aumentar o risco de recaídas após tratamento. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Ainda não há dados suficientes para avaliar se a Lepra pode acelerar a evolução da infecção por HIV para o SIDA. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Tratamento do doente</span></span></span></span></p><p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Com base nos dados acima mencionados, recomenda-se que: </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1. Os doentes de Lepra devem tomar o tratamento TMAA consoante a sua classificação, independentemente de</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">serem ou não seropositivos. O esquema de tratamento TMAA não requer nenhuma modificação nestes doentes. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2. È preciso ter para com os doentes que têm Lepra , os mesmos cuidados</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">que se têm em relação à protecção contra a infecção pelo HIV. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center;text-indent:35.4pt"><u><span style=" Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">7. DIAGNÒSTICO</span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os pontos que devem ser seguidos quando um doente se apresenta com sinais de suspeita de Lepra são os seguintes:</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Exame clínico para a lepra, que inclui os seguintes procedimentos:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1. Fazer uma história clínica resumida</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2. Mandar despir o doente e observar o estado de toda a pele</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">3. Avaliar os nervos periféricos (tamanho dos troncos nervosos periféricos, presença ou ausência de dor à palpaçao suave e feita delicadamente)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">4. Executar os testes de sensibilidade nas eventuais lesões da pele( manchas hipocrómicas )</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">5. Executar os testes de sensibilidade nas extremidades (mãos e pés )</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">6. Efectuar baciloscopia nas lesões e nos lóbulos das orelhas (se possível)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">7. Decidir se o doente tem Lepra (diagnóstico de lepra)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">8. Classificar a forma de Lepra (classificação operacional)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">9. Avaliar se a Lepra está em fase activa ou inactiva.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10. Registar o doente, preenchendo correctamente a ficha clínica.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">11. Avaliar a presença de complicações da Lepra (reacções, danos sensoriais, danos</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">motores), especialmente nos olhos, e registar o grau de deformidades do doente</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">12. Fazer educação sanitária individual, virada para os problemas encontrados</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">específicamente em cada doente.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">13. Iniciar a terapêutica de .medicamentos associados. (TMA) adequada</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">14. Avaliar a presença de complicações da Lepra (reacções, danos sensoriais, danos</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">motores), especialmente nos olhos, e registar o grau de deformidades do doente</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">15. Dar educação sanitária individual, orientada para os problemas encontrados.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">É muito importante ganhar o hábito, de seguir os pontos acima listados sempre na mesma ordem, para</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">evitar esquecer alguns procedimentos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os sinais cardinais para o diagnóstico clínico da Lepra são: Lesões cutâneas com perda de sensibilidade (normalmente manchas hipocrómicas mas podem ser papulas, nódulos e ou placas),espessamento dos nervos e presença de bacilos álcool-ácido resistentes nos esfregaços da pele.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="margin-left:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Exames laboratoriais</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esfregaço de incisão de pele</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">: Faz-se uma pequena incisão na pele, o local é em seguida raspado para obter liquido tecidual com o qual o esfregaço é preparado e examinado após a coloração de Zichl – Neelsen. As amostras costumam ser obtidas de ambos os lobos das orelhas e duas outras lesões activas. </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O índice bacteriano ( IB) é calculado de acordo o seguinte quadro.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Quadro do índice bacteriano(IB)-escala logaritimica de Ridley</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt; mso-yfti-tbllook:480;mso-padding-alt:0cm 5.4pt 0cm 5.4pt;mso-border-insideh: .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style=" line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O</span></span></span></span></span><span style="Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt: solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style=" line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">não se obseravaram bacilos em campos com aumento de 100 vezes</span></span></span></span></span><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><st1:metricconverter productid="1 a" st="on"><span style="line-height:150%; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1 a</span></span></span></span></span></st1:metricconverter><span style="line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 10 bacilos observados em campos com aumento de 100 vezes</span></span></span></span></span><span style="Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:2"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><st1:metricconverter productid="1 a" st="on"><span style="line-height:150%; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1 a</span></span></span></span></span></st1:metricconverter><span style="line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 10 bacilos observados em campos com aumento de 10 vezes</span></span></span></span></span><span style="Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:3"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">3+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><st1:metricconverter productid="1 a" st="on"><span style="line-height:150%; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1 a</span></span></span></span></span></st1:metricconverter><span style="line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 10 bacilos observados em campo medio</span></span></span></span></span><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:4"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">4+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><st1:metricconverter productid="10 a" st="on"><span style="line-height:150%; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10 a</span></span></span></span></span></st1:metricconverter><span style="line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 10o bacilos observados em campo medio</span></span></span></span></span><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:5"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">5+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><st1:metricconverter productid="100 a" st="on"><span style="line-height:150%; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">100 a</span></span></span></span></span></st1:metricconverter><span style="line-height:150%;mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 1000 bacilos observados em campo medio</span></span></span></span></span><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:6;mso-yfti-lastrow:yes"> <td width="307" valign="top" style="width:230.25pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">6+</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="307" valign="top" style="width:230.25pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"; mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Muitos agregados de bacilos (>1000) em campo médio.</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">São observados IB</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">negativos </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">nos casos paucibacilares, casos tratados e nos casos examinados por um técnico inexperiente.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esfregaços ou raspados nasais</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">: Não são mais recomendados</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Cultura: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">o</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">M. leprae tem sido cultivado in vitro o; entretanto, cresce quando inoculado no coxim da platar do camundongo. As culturas bacterianas de rotina são realizadas para descartar infecção secundaria.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">PCR</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">: o DNA de M. leprae detectado por essa técnica firma o diagnostico de lepra paucibacilar em estado inicial e identifica M. leprae após terapia.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Dermatopatologia: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">a TL caracteriza-se por granulomas de célula epiteloides que surgem em trono dos nervos da derme; os bacilos álcool-ácido- resistentes estão eparsos ou ausentes. A LL apresenta um extenso inflitrado celular, separado da epiderme por uma estreita zona de colageno normal. Os apêndices cutâneos são destruídos. Os macrofagos estão repletos de M. leprae e possuem citoplasma adundante espumoso ou vacuolado (célula da lepra ou célula de Virchow).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">8. DIAGNÓSTICO DIFERENCIAL</span></span></span></span></span></u><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra tuberculoide</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">: dermatofitose epidérmica (tinha do corpo), pitiríase alba, pitiríase versicolor, dermatite saborreica, vitiligo, oncocercose, discromia nutrucional.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra lepromatosa: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">granuloma anular, sarcoidose, tuberculose cutânea, infecção por micobacterias atípicas, granulomatose de Wegner, leishnaniose, dérmica pós-calazar, neurofibromatose, necrobiose lipoídica, doença de Kaposi.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepra limítrofe (borderline): </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">sífilis tardia, lúpus eritematoso, eritema anular, leishnaniose cutânea, micose fungoide. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Neuropatia periférica:</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> atrofia muscular fibular (doença de Charcot-Marie-Tooth), doença de Déjerine-Sottas (neurite intersticial hipertrofica familiar), amiloidose primaria de nervos periféricos, seringomielia, tabes dorsalis, neuropatia radicular sesorial hereditária, insensibilidade congénita a dor, neuropatia perifeica de varias etiologias.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Muitos BAAR em amostras de biopsia da pele ou outros tecidos. </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Infecaço pelo complexo M. avium-intracelulare em indivíduos infectados pelo HIV.</span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.45pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Incluída no diagnóstico diferencial das lesões que se assemelham a lepra estão: sarcoidose, leishnaniose, lupos vulgares, linfoma, sifliles, bouga, branuloma anular e muitos outros estudos que causam hipopigmentação. A saicoidose pode resultar em inflamação do perneuro, mais a formação verdadeira de glanulomas dentro dos nervos dérmicos é patagnomonico da lepra. Na lepra lepromatosa as amostras de escarros podem conter grande quantidade de BAAR- achado que pode ser inadequadamente interpretado como manifestação da tuberculose pulmonar. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">9. COMPLICAÇÕES</span></span></span></span></span></u><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Nos membros:</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> As complicações dos membros são primariamente consequências de neuropatias ocasionando insensibilidade e miopatia. A insensibilidade atinge os receptores sensoriais do tacto, dor e temperatura, mas em geral poupa as sensações proprioceptivas e vibratória.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O tronco neural mais comum é o nervo ulnar e cotovelo cujo o acometimento resulta em pinçamento do quarto e quinto dedo, perda da musculatura interóssea dorsal na mão e perda sensibilidade nestas distribuição. O acometimento do nervo mediano na lepra debilita a oposição do polegar e a preensão, enquanto a disfunção do nervo radial embora rara na lepra leva ao punho caído. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A ulceração plantar principalmente na cabeça do metatarso é provavelmente a neuropatia que é mais frequente na Hanseniase. Estas úlceras podem infectar-se e causar celulite e oseomielite.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">As paralisia do nervo</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">fibular, resutantes da lepra oudo estados reacionais, causam pé caído, o que causa uma distribuição irregular do peso na superfície plantar e portanto maior tendência á ulceração..</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A perda de falanges distais dos dedos também são consequência da insensibilidade, traumatismo e infecção secundária e algumas vezes processos osteoliticos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">No nariz</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">: na lepra lepromatosa a invasão bacilar na mucosa nasal pode resultar em congestão nasal crónica e epixtases. A lepra lepromatosa não tratada pode levar a destruição da cartilagem nasal com consequente deformação do nariz em sela ou anosmia.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">No olho:</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> devido a paralesia dos nervos cranianos causa lagoftalmia, perda da sensibilidade da córnea podem complicar a lepra resultando infecções secundadrias, ulcerações e opacificaçao da córnea. Na lepra lepromatosa a câmara anterior do olho é invadida por bacilos e o ENL pode resutar</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">em uveite com consequente catarata e glaucoma. Sendo a lepra uma causa importante de cegueira nos pais em desenvolvimento.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Testículos: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">o m. leprae invade os testículos, ao passo que o ENL pode causar orquite. Frequentemente a manifestação de disfunção testicular leve ou grave com diminuição da testorona, hipoespermia e elevação das hormonas luteinizante e foliculoestimulante. </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Amiloidose: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">é uma complicação secundaria da lepra LL e ENL encontrada com pouca frequência na era da antidioticoterapia, podendo resultar em anormalidades da função hepática e principalmente da função renal.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;line-height:150%"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">10. EVOLUÇÃO E PROGNÓSTICO</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Depois do primeiros anos de</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">tratamento farmacológico, o problema masi difícil consiste em tratar as alterações secundarias nos deficeis neurológicos, contraturas e alterações tróficas das mãos e dos pes. Isso requer uma equipe profissional de saúde: cirurgiões ortopédicos, cirurgiões na mão, especialistas em pé, oftalmologista, neurologista, fisioterapeuticas e profissionais de reabilitação. Em raros casos a amiloidose secundária com insuficiência renal pode complicar a lepra de longa duração. As reacções tipo 1 da lepra duram 2 a4 meses em indivíduos com BT e ate 9 meses nos indivíduos com BL. Ocorrem reacções tipo 2 da lepra (ENL) em 50% dos paciente com LL e em 25% dos indivíduos com BL nos primeiros anos de tratamento. O ENL pode ser complicado por uveite, dactilite, artrite, neurite, linfadenite, miosite e orquite. A reacção ou fenómeno de Lúcio ocorre secundarimente à vasculite, com infarto subsequente</span></span></span><u><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">. </span></span></span></u></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">11. TRATAMENTO</span></span></span></span></u></p><p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="margin-left:18.0pt;text-indent:17.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os princípios gerais do tratamento são:</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Erradicar a infecção com a terapia antilepromatosa;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Evitar e tratar as reacções;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Reduzir o risco de lesão do nervo;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Educar o paciente para lidar com a neuropatia e a anestesia;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Tratar as complicações da lesão do nervo;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="margin-left:54.0pt;text-indent:-18.0pt;line-height: 150%;mso-list:l6 level1 lfo2;tab-stops:list 54.0pt"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;"><span style="mso-list:Ignore"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">·</span></span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Reabilitar o paciente na sociedade.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">O tratamento envolve uma abordagem multidisciplinar ampla que inclui cirurgia ortopédica, oftalmologia e fisioterapia.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Terapia das reacções </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="line-height:150%;mso-list:l1 level1 lfo3; tab-stops:list 36.0pt"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Reacções tipo 1 da lepra : </span></span></span></span></u><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">prednisona, </span></span></span><st1:metricconverter productid="40 a" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">40 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 60 mg/dia ; a dosagem deve ser gradualmente reduzida durante um período de </span></span></span><st1:metricconverter productid="2 a" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 3 meses .</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> </ul> <p class="MsoNormal" style="line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esta indicada para neurite , lesões que ameaçam ulcerer e lesões que surgem em locais esteticamente importantes(face).</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="line-height:150%;mso-list:l1 level1 lfo3; tab-stops:list 36.0pt"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Reacções tipo 2 da lepra (ENL): </span></span></span></span></u><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">prednisona </span></span></span><st1:metricconverter productid=",40 a" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">,</span></span></span><span style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">40 a</span></span></span></span></st1:metricconverter><span style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 60 mg/dia ,reduzidos gradualmente bem rapidamente ; </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">talidomida </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">para ENL recorrente , </span></span></span><st1:metricconverter productid="100 a" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">100 a</span></span></span></st1:metricconverter><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 300 mg/dia . </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="line-height:150%;mso-list:l1 level1 lfo3; tab-stops:list 36.0pt"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Reacções de lúcio : </span></span></span></span></u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">nem a prednisona nem a talidomida são muito eficazes , </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Prednisona </span></span></span><st1:metricconverter productid=",40 a" st="on"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">,</span></span></span><span style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">40 a</span></span></span></span></st1:metricconverter><span style=""><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> 60 mg /dia , reduzidos gradualmente</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">e de forma rápida .</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></li> </ul> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Agentes antimicrobianos sistémicos: </span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">são usados quando existe infecção secundária das ulcerações para evitar infecções mais profundas ,como a osteomielite .</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-indent:35.4pt;line-height:150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Cuidados ortopédicos :</span></span></span></span><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> devem-se usar talas ortopédicas para evitar contraturas das regiões desnervadas .Atenção especial aos cuidados com os pés para evitar ulceração neuropática . </span></span></span><sup><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">( será abordado como reabilitação física )</span></span></span></sup><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esquemas antimicrobianos recomendados para o tratamento da lepra em </span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">adultos </span></span></span></span></p> <div align="center"> <table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt; mso-yfti-tbllook:480;mso-padding-alt:0cm 5.4pt 0cm 5.4pt;mso-border-insideh: .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes"> <td width="192" valign="top" style="width:144.05pt;border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Forma de lepra </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.05pt;border:solid windowtext 1.0pt; border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt: solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esquema mais intensivo</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.1pt;border:solid windowtext 1.0pt; border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt: solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Esquema recomendado pela O.M.S (1982)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:1"> <td width="192" valign="top" style="width:144.05pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Tuberculóide (paucibacilar)</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.05pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Dapsona (100mg/dia ) durante 5 anos </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.1pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Dapsona (100mg/dia, não suprvisionado) + rifampicina (600 mg/mês supervisionado) →durante 6 meses </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:2;mso-yfti-lastrow:yes"> <td width="192" valign="top" style="width:144.05pt;border:solid windowtext 1.0pt; border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Lepromatosa (multibacilar )</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.05pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Rifampicina (600mg/mês) durante 3 anos + dapsona (100mg /dia ) indefinidamente </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> <td width="192" valign="top" style="width:144.1pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt; mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt"> <p class="MsoNormal"><span style="font-family:"Arial","sans-serif";mso-fareast-font-family:SimSun;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Dapsona (100 mg / dia ) + clofazimida ( 50 mg/dia , não supervisionado ) ; e</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">rifampicina(600mg ) +clofazimina (300mg) mensalmente → durante 1 ano </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> </td> </tr> </tbody></table> </div> <p class="MsoNormal" style="margin-left:70.8pt;text-indent:35.4pt"><sup><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">fonte : dermatologia –atlas e texto . Fitzpatrick</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></sup></p> <p class="MsoNormal"><sup><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></sup></p> <p class="MsoNormal" style="margin-left:35.4pt;text-indent:35.4pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Contra indicações e precauções </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <ul style="margin-top:0cm" type="disc"> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l8 level1 lfo4; tab-stops:list 36.0pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A rimfampicina não deve ser administrada com insuficiência hepática ou renal grave ;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l8 level1 lfo4; tab-stops:list 36.0pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Em doentes com anemia grave ,deve-se aguardar que o nível de hemoglobina seja aumentado mediante tratamento adequado antes de iniciar a terapêutica com dapsona ;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l8 level1 lfo4; tab-stops:list 36.0pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os doentes com alergia medicamentosa às sulfonas ,como por exemplo :fansidar ,cotrimazol , não devem tomar dapsona ;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l8 level1 lfo4; tab-stops:list 36.0pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Quando houver dor abdominal ou diarreia crónica intermitente deve-se evitar o uso de clofamzimina ;</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> <li class="MsoNormal" style="text-align:justify;line-height:150%;mso-list:l8 level1 lfo4; tab-stops:list 36.0pt"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Os doentes que sofrem de tuberculose pulmonar activa devem receber quimioterapia adicional adequada.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></li> </ul> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Ainda no tratamento estabelece-se a comparação entre dois tipos de doentes o que torna o controlo da lepra mais eficaz , são nomeadamente : </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">- </span></span></span><u><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Doente regular : </span></span></span></u><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">aquele que consegue tomar 6 doses mensais no período de 6 meses ; e </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">- </span></span></span><u><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Doente reentrado após abandono : </span></span></span></u><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">assim notificado por ter abandonado a terapia , e após regresso é submetido a um novo exame clínico ( se possível com baciloscopia ); se apresentar sinais de actividade reinicia o tratamento ou “completa” as doses iguais ao do doente regular.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <div align="center"> <table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="576" style="width:432.05pt;margin-left:3.5pt;border-collapse:collapse;mso-padding-alt: 0cm 3.5pt 0cm 3.5pt"> <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:13.25pt"> <td width="180" nowrap="" colspan="2" valign="bottom" style="width:135.0pt;padding: 0cm 3.5pt 0cm 3.5pt;height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Tratamento Concluído</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa cura PB%</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Taxa cura MB%</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Curados PB%</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Curados MB%</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:1;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2002</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">4272</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">64</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">55</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">309</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">678</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:2;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2003</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2933</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">64</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">57</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">232</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">578</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:3;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2004</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2108</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">67</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">61</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">383</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">853</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:4;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2005</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1877</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">50</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">60</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">231</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">600</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> </tr> <tr style="mso-yfti-irow:5;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2006</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1309</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">70</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">286</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> </tr> <tr style="mso-yfti-irow:6;mso-yfti-lastrow:yes;height:13.25pt"> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">2007</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="90" nowrap="" valign="bottom" style="width:67.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal" align="right" style="text-align:right"><span style="Arial","sans-serif";mso-fareast-language: ZH-CNfont-family:";"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">1269</span></span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></span></p> </td> <td width="101" nowrap="" valign="bottom" style="width:75.65pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> <td width="114" nowrap="" valign="bottom" style="width:85.5pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> <td width="91" nowrap="" valign="bottom" style="width:67.95pt;padding:0cm 3.5pt 0cm 3.5pt; height:13.25pt"> <p class="MsoNormal"><span style="Arial","sans-serif"; mso-fareast-language:ZH-CNfont-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> </td> </tr> </tbody></table> </div> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" align="center" style="text-align:center"><u><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">13. PREVENÇÃO E CONTROLO </span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></u></p><p class="MsoNormal" align="center" style="text-align:center"><span class="Apple-style-span" style="text-decoration: underline; "><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A vacinação ao nascimento com o bacilo Calmette-Guérin</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">(BCG) tem mostrado eficácia irregular na prevenção da lepra, variando desde totalmente ineficaz ate 80% de eficácia. O acréscimo de M. leprae morto pelo calor ao BCG não aumenta a eficácia da vacina como a micobacteria total contem grandes quantidades de lipidos e carboidratos que se comprovou in vitro serem imunosupressores para linfocitos e macrofagos, as proteínas do M. leprae podem ser vacinas de qualidade superior.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">A quimioproflaxia com dapsona pode reduzir o numero de casos de lepra tuberculoide mas não de lepromatosa e portanto não é recomendada mesmo pra os casos de contactos domésticos.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">Como a transmissão da lepra parece necessitar de um contacto intimo prologando, os paciente</span></span></span><span style="mso-spacerun:yes"><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;">hospitalizados não necessitam de ser isolados.</span></span></span><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><o:p></o:p></span></span></span></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:35.4pt;line-height: 150%"><span style="Arial","sans-serif"font-family:";"><o:p><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"> </span></span></span></o:p></span></p> <p class="MsoNormal" align="center" style="text-align:center"><b style="mso-bidi-font-weight: normal"><u><span style="Arial","sans-serif"font-family:";"><o:p><span style="text-decoration:none"><br /></span></o:p></span></u></b></p><p></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3861437640803534845.post-48233773879039946982008-11-10T18:14:00.000+01:002008-11-10T23:41:00.363+01:00Fisiopatologia da Mama<div style="text-align: justify;">Exame Físico: <br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div><div style="text-align: justify;">Inspecção<br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">A inspecção permite revelar as dimensões e a forma da glândula, e as eventuais anomalias congênitas (amastia, amazia, micromastia, polimastia, hipertrofia mamária, atelia).</div><div style="text-align: justify;">A pele da mama poderá apresentar-se edemaciada, com ou sem sinais inflamatórios, àreas de depressão, abaulamentos, ulcerações ou nódulos cutâneos. É frequênte o achado de veias visíveis sobre as duas mamas , o que não tem valor diagnótico, excepto se as veias forem visíveis de um só lado.</div><div style="text-align: justify;">A pele</div><div style="text-align: justify;"> porá estar fixa a um nódulo, por exenplo um tumor maligno, caracterizando o grau de fixação se pedirmos a doente para levantar os braços açima da cabeça.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikRTnEZLhu1iC77VdrdM3w3-34VQ7vu-0bRmYI4GCcXkyB7eF2ozy9tqtwXVncN4WEtoon6dhKrO5TKTDTCE0_IbTGTqMRfoMLByZIYJWQy9wO0C03m1hTAmEjajadpTcVs0bpbi1t3QM/s320/chuveiro.gif" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 186px; height: 240px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5267101932716282962" /><div style="text-align: justify;">Palpação</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"> A palpação mamária deverá ser feita com a polpa dos dedos, com o doente em posição sentado, de pé ou deitado. Dadas as alterações na concistência e sensibilidade da mama, relacionada com os períodos menstruais, a melhor altura para a mama ser palpada , é depois do período menstrual, após o desaparecimento da congestão que frequentemente </div><div style="text-align: justify;">acompanha o período pré- menstrual e menstrual, permitindo assim uma melhor identificação das características do parênquima.</div><div style="text-align: justify;">Deve-se palpar toda mama, seguindo uma ordem fixa, o que para tal é costume dividi-la em quatro quadrantes, definidos por duas linhas perpendiculares que se cruzam sobre o mamilo. Após a palpação dos quatro quadrantes, a região retro-areolar e do mamilo é igualmente palpada. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Mastites</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Traduz-se como a inflamação da mama. Consoante o agente etiológico poderá apresentar-se de forma aguda ou crónica, se</div><div style="text-align: justify;">ndo a etiologia tuberculosa a causadora mais frequente de mastite crónica.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Mastite Tuberculosa</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Tem como características principais uma evolução arrastada, dando origem a uma tumefa</div><div style="text-align: justify;">ção mal definida, ou noutros casos, a um endurecimento difuso da própria glândula, podendo abservar-se a presença de um ou mais sinus. A pele muitas vezes é fixa a tumefação inflamatória, o que torna difícil em muitos casos o diagnóstico diferencial com o carcinoma da mama. Frequentemente acomete os gânglios axilares, que aumentam de volume, sendo a primeira manifestação de tuberculose com envolvimento da mama através dos linfáticos por via retrógada.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Mastite Do Recém-Nascido</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Surge por volta do terceiro ou quarto dia de vida, com secreção de um fluido sem cor </div><div style="text-align: justify;">à expressão do mamilo. Alguns dias depois, a secreção pode tornar-se leitosa, desaparecendo por volta da terceira semana de vida. Ela ocorre por estimulação do tecido mamario do feto, pelas hormonas m</div><div style="text-align: justify;">aternas circulantes. </div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Mastite De Lactação</div><div style="text-align: justify;"><br /></div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPLw_TYNwAJS_F52nUsNx63lJ09YuQk0GGG4JScxbPgzhdZN-dWMlCwv0IWhufNJoEtekGIrlyp09GxkH6U4qZ-9jbNZGV2wY6218BHLZNTZSzLNLrkSdhs_bfqrzgoF3DL2Iq1S7T1gw/s320/images.jpg" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 107px; height: 76px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5267161585581489874" /><div style="text-align: justify;">É a mais frequente das mastites agudas, e geralmente unilateral. A mama apresenta-se aumentada de volume com sinais inflamatórios clássicos, inicialmente numa àrea endurecida, podendo atingir toda mama, com formação de abcessos de localização variável itramamários, retromamários e subareolares. Esses abcessos devem-se à penetração através dos canais galactóforos de germes patogênicos apartir do mamilo.</div></div>Unknownnoreply@blogger.com0