Sindroma de ulisses

1. Ulysses´ssyndrome
(A saga de Ulisses)
Manuel Salgado
Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra, CHUC
15.10.2015

2. Sindromade Ulisses
-Médico
-Social

3. “Ulisses, herói grego, rei de Ítaca, foi um dos elementosmais decisivos no cerco a Tróia… O retorno de Ulisses à sua terra, … é o tema da Odisseia… O azar ou a má sorte
-a inimizade de Neptuno …, as ciladas várias, … o Inferno, … um emaranhado tenebroso … obrigaram o herói e seus companheiros a errarem pelos mares durante dez longos anos, perdidos por mauscaminhose sujeitos a amargos e demoradossacrifícios”.

4. “… Também as sereias sujeitaram Ulisses a provações. Com as suas melodias maviosas e enganadoras …

5. “Para resistir às tentações… o herói tapou com cera os ouvidos dos seus companheiros e pediu-lhes que o amarrassem bem ao mastro do navio”.

6. A analogia da Odisseia de Ulissescom os mauscaminhos, enganos, e sacrifíciospassados por estes pacientes, … levou a denominar de Sindroma de Ulissesestaforma de iatrogenia, caracterizada por:
-extensivas e desnecessárias investigações,
-resultantes da tentativa de esclarecimento de achado insignificante:
•clínico,
•laboratorialou
•imagiologia.
Salgado M., Fonseca N. A Síndrome de Ulisses. Saúde Infantil 1993;15:83-4

7. IntJ Environ Res Public Health.2009 May;6(5):1649-64. doi: 10.3390/ijerph6051649. Epub2009 May 14.
The risks of inappropriateness in cardiac imaging.
PicanoE.
Author information
Institute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it
Abstract
The immense clinical and scientific benefits of cardiovascular imaging are well- established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A- type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiologicalcheck-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs, unaffordable even by the richest society, and unacceptable risks.

8. PicanoE. The risks of inappropriateness in cardiac imaging
IntJ Environ Res Public Health.2009 May;6(5):1649-64. doi: 10.3390/ijerph6051649. Epub2009 May 14.

9. J Lab ClinMed.2004 Jul;144(1):7-10. Did Ulysses have porphyria? PierachCA. … An errant patient with a conundrum of symptoms but without an explanation for them might have to take iatrogenic detours only to learn after what are at times ulysseanvagaries that the initial diagnosis of porphyriais in the end untenable. …. the occurrence of the Ulysses syndrome can be curtailed through the careful ordering of tests and cogent interpretation of their results.
Em Hematologia

10. •Eugenio Picano, GaetanoMottola. Ulysses’ Syndrome. Stress Echocardiography 2003;469-75.
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1º

11. Stress Echocardiography2003;469-475 Ulysses’ SyndromeEugenio Picano, GaetanoMottolaAbstractDetecting myocardial ischemia can now be done using a wide ranging —somewhat confusing —series of tests: a plethora of diagnostic approaches with a variety of stresses (physical, electrical, and pharmacological) in combination with all the available technologies, from the well-established tools (e.g., electrocardiography), to the more recent imaging techniques (nuclear cardiology, echocardiography), up to the latest, most sophisticated, and expensive ones (magnetic resonance, ultrafast computed tomography, positron emission tomography). These imaging techniques provide noninvasive insight into myocardial function and metabolism in a polychrome, three-dimensional, almost overwhelming fashion [1]. Not infrequently, the patient’s complexity is reduced to a transient perfusion defect or a reversible hypokinesia, and technological output replaces integrated clinical reasoning [2,3].

12. Diluições
O inverso das diluições = Títulos

13. Análises com resultados em Títulos
Um dos múltiplosexemplos de potencial “criação” de síndroma de Ulisses médico

14. Obrigado pela vossa atençãoContacto: reumatologia@chc.min-saude.pt

15. Neologismo = palavra ou expressão nova, formada no interior da língua ou importada…

16. What is the " Ulysses Syndrome "? Ulysses syndrome is characterized by the following hot spots: -Loneliness: Once a person comes to a country that is not yours is just a bleak outlook . They can not bring the family because they first have to have economic stability. Furthermore, the fact that their closest relatives , as their children, especially in the case of women , have been left in the home country produces a nostalgia hard to beat. -The feeling of failure. They think that so much effort has served not because they can not progress in the market and can not get jobs . They live very tough situations in the struggle for survival. Their main concern is where to eat and where to sleep . -Spend scary situations. For example , it is common is arriving in boats feel dread, soon after, the water.
http://www.bubblews.com/news/1459210-what-is-the-quot-ulysses-syndrome-quot
Síndroma de Ulisses Social

17. Exemplos de Exames na origem de Síndroma de Ulisses
-Título TASO
-Título ANAs
-TtuloAcDsDNA
-RA teste e /ou Waaler-Rose positivos
-Reação Widal
-...
-Alterações do ECG (electrocardiograma)
-RX do tórax
-múltiplos outros…