Anatomy of the lower hypogastric plexus applied to endometriosis: a narrative review

ABSTRACT Objective The objective of the present study is to evaluate the anatomy of the inferior hypogastric plexus, correlating it with urological pathologies, imaging exams and surgeries of the female pelvis, especially for treatment of endometriosis. Material and Methods We carried out a review about the anatomy of the inferior hypogastric plexus in the female pelvis. We analyzed papers published in the past 20 years in the databases of Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials, and opinions of specialists. We also studied two human fixed female corpses and microsurgical dissection material with a stereoscopic magnifying glass with 2.5x magnification. Results Classical anatomical studies provide few details of the morphology of the inferior hypogastric plexus (IHP) or the location and nature of the associated nerves. The fusion of pelvic splanchnic nerves, sacral splanchnic nerves, and superior hypogastric plexus together with visceral afferent fibers form the IHP. The surgeon's precise knowledge of the anatomical relationship between the hypogastric nerve and the uterosacral ligament is essential to reduce the risk of complications and postoperative morbidity of patients surgically treated for deep infiltrative endometriosis involving the uterosacral ligament. Conclusion Accurate knowledge of the innervation of the female pelvis is of fundamental importance for prevention of possible injuries and voiding dysfunctions as well as the evacuation mechanism in the postoperative period. Imaging exams such as nuclear magnetic resonance are interesting tools for more accurate visualization of the distribution of the hypogastric plexus in the female pelvis.

Sigilo, confidencialidade e privacidade: perspectivas pedagógicas na Estratégia Saúde da Família / Secrecy, confidentiality and privacy: educational perspectives in the Family Health Strategy / El secreto, la confidencialidad y la privacidad: perspectivas en el proceso educativo sobre la Estrategia de Salud de la Familia

A investigação dos problemas bioéticos na Estratégia Saúde da Família (ESF) permanece, ainda, como tema negligenciado nas publicações acadêmicas contemporâneas, a despeito das candentes questões que se apresentam nessa esfera da atenção à saúde. Nesse âmbito, elementos atinentes à relação entre usuários e profissionais de saúde ganham relevância. O estudo dessa temática é mote do presente artigo, no qual são apresentados resultados obtidos junto aos profissionais da ESF do município de Viçosa/MG, durante a realização de oficina de formação em bioética e Atenção Primária à Saúde ­ enfatizando as conversações sobre o sigilo, a privacidade e a confidencialidade ­ desenvolvidas ao longo do processo pedagógico. (AU)

The investigation of bioethical issues in the Family Health Strategy (FHS) still remains a neglected theme in contemporary scholarly literature, despite the pressing issues that arise in this sphere of health care. In this context, elements related to the relationship between users and health professionals gain relevance. The study of this theme is the mote of this article, in which results obtained from FHS professionals in the county of Viçosa/MG, while they trained and attended a workshop on bioethics and Primary Health Care, are presented ­ emphasizing conversations regarding secrecy, privacy and confidentiality developed throughout the educational process. (AU)

La investigación de las cuestiones de bioética en la Estrategia de Salud de la Familia (ESF) todavía permanece como tema descuidado en las publicaciones académicas contemporáneas, a pesar de los temas candentes que se plantean en esta esfera de la atención a la salud. En este contexto, sobre la relación entre los usuarios y profesionales de la salud se convierten en elementos más importantes. El estudio de este tema es el tema de este artículo, en el que los resultados obtenidos se presentan junto a los profesionales de la ESF de la ciudad de Viçosa/MG, mientras la realización de la formación en bioética y taller de formación primaria de salud ­ haciendo hincapié en las conversaciones sobre el secreto, la privacidad y confidencialidad ­ desarrollado durante el proceso educativo. (AU)

Identification of priority areas for landscape connectivity maintenance in the Xingu Area of Endemism in Brazilian Amazonia

Forest fragmentation has been intense in the eastern Amazon region, which has negatively affected wildlife populations. The speed of deforestation in this region underscores the urgent need to understand the effects of such changes on populations of endemic species, and to implement measures for ecosystem conservation. We analyzed the extent to which fragmented forests are still connected in the Xingu Area of Endemism, in the eastern Brazilian Amazon, and assigned conservation priority to fragments most important for connectivity maintenance. We structurally classified the Xingu landscape using the Morphological Spatial Pattern Analysis and ranked each fragment according to its importance using an Index of Connectivity. Our data revealed important differences in conservation potential across the region. Although most of the study area already receives some degree of protection, future conservation actions should prioritize the connection of habitat fragments to maximize dispersal potential and minimize genetic isolation of biodiversity components. We produced a map of prioritary areas for connectivity maximization. These areas include fragments with large core areas and high-quality fragments that provide connection among habitats which, together, should maintain crucial corridors for gene flow in a biologically-rich region of the Amazon. (AU)

Enucleación esofágica de leiomioma asistida por robot: reporte de un caso y revisión de la literatura / Case report of robot-assisted esophageal enucleation of leiomyoma and literature review

Resumen Introducción: los leiomiomas esofágicos son tumores benignos, que son resecados por enucleación esofágica cuando son mayores de 5 cm o en lesiones de cualquier tamaño que sean sintomáticos o sospechosos de malignidad. Tradicionalmente, se ha realizado la resección por técnica de enucleación abierta; sin embargo, la cirugía mínimamente invasiva ha surgido como una técnica con grandes ventajas y, en especial, la tecnología robótica parece ofrecer ventajas. Caso clínico: se reporta un caso de leiomioma esofágico del esófago medio con enucleación mediante el uso de una técnica toracoscópica asistida por robot. La esofagoscopia intraoperatoria y la transiluminación fueron complementos útiles para identificar el esófago y desarrollar un plano de disección extramucosa seguro, que junto con la asistencia robótica parecen minimizar los riesgos intraoperatorios, entre ellos, potencialmente la probabilidad de lesión mucosa, y mejoran el tiempo de recuperación postoperatoria.

Abstract Introduction: Esophageal leiomyomas are benign tumors which are resected by esophageal enucleation when they are symptomatic, suspected of malignancy, or larger than 5 cm. Traditional resection uses the open enucleation technique, but minimally invasive surgery has emerged as a technique that has great advantages, especially when combined with robotic technology. Case report: We report a case of leiomyoma of the middle esophagus with treated with enucleation using a robotic-assisted thoracoscopic technique. Intraoperative esophagoscopy and transillumination were useful for identifying the esophagus and developing a plan of safe extra mucosal dissection. Together with robotic assistance this seems to minimize intraoperative risks including that of mucosal injury while also improving postoperative recovery time.

Identificação do estresse em trabalhadores do período noturno / Identification of stress among night shift workers

Resumo Introdução. O aumento gradativo na quantidade de empresas que oferecem prestação de serviços 24 horas impacta no aumento da procura e recrutamento de sujeitos que desempenhem serviços no período da noite. O trabalho noturno provoca alterações no organismo que, associadas a situações de estresse, se manifestam através de sintomas físicos e psicológicos podendo desencadear em doenças do trabalho. Objetivo. Identificar o nível de estresse dos trabalhadores noturnos de uma empresa responsável pelo recebimento, envio e entrega de correspondências no Brasil. Materiais e métodos. Trata-se de um estudo transversal, quanti-qualitativo, exploratório e descritivo. Participaram 31 sujeitos, 29 homens e duas mulheres, com média de idade de 46 anos. Para coleta de dados utilizou-se uma anamnese e o Inventário de Sintomas de Estresse para Adultos. Resultados. Mesmo que a maior parte dos trabalhadores não possua diagnóstico de estresse significativo, uma parcela considerável atribuiu ao ambiente de trabalho o aumento do estresse vivenciado. Apenas os trabalhadores que apresentaram níveis diferenciados de estresse, possuem interferência deste nas ocupações. Conclusão. Acredita-se que medidas preventivas, no âmbito organizacional e/ou pessoal, podem ser estratégias adequadas para promoção da qualidade de vida dos trabalhadores.

Abstract Introduction: The gradual increase in the number of companies that offer 24-hour services impacts the growing demand and recruitment of individuals to deliver these services at night. Working at night causes changes in the body that are associated with stress, which manifests through physical and psychological symptoms and may trigger work-related diseases. Objective: The aim of this research was to identify the stress level of night workers of a company responsible for receiving, sending and delivering mail in Brazil. Materials and methods: Cross-sectional, quantitative, qualitative, exploratory and descriptive study. Participants included 31 subjects, 29 men and 2 women, with a mean age of 46 years. For data collection, anamnesis and the Stress Symptom Inventory for Adults were used. Results: Even though most workers are not diagnosed with significant stress episodes, a considerable portion attributed increased stress to the work environment. Only workers with different levels of stress experience interference while performing their jobs. Conclusion: Preventive measures, both in organizational and/or personal ambits, may be adequate strategies to promote the quality of life of workers.

Treatment with Sofosbuvir and Daclatasvir (with or without Ribavirin) Improves Patient Reported Outcomes in Hepatitis C

OBJECTIVES: To evaluate the impact of 3 treatment regimens upon health-related quality of life and work productivity using patient-reported outcomes (PROs) in chronic hepatitis C infected patients: sofosbuvir (SOF) + daclatasvir (DCV); SOF + DCV + ribavirin (RBV); SOF + simeprevir (SMV). METHODS: 4 questionnaires were used to evaluate PROs before, during and after treatment: Short Form-36 (SF-36), Chronic Liver Disease Questionnaire (CLDQ) - hepatitis C virus (HCV), Work Productivity and Activity Index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). RESULTS: Of the global sample of 55 patients included in this study; SOF + DCV (n = 10); SOF + DCV + RBV (n = 29); SOF + SMV (n = 16) all had a statistically significant improvement in SF-36, CLDQ and FACIT-F scores during and post-treatment. No statistically significant differences in the PRO questionnaire values were observed between the distinct treatment regimens. The SOF and SMV patient groups presented higher mean PRO variations during and post-treatment, compared to the other groups: SF-36 functional capacity (16.1); SF-36 mental health (21.4); CLDQ activity (1.8); CLDQ emotional function (1.2); FACIT-F physical well-being (8.0); Total FACIT-F (21.6). CONCLUSION: Treatment with SOF + DCV, with or without RBV, results in an improved PRO similar to treatment with SOF + SMV in chronic hepatitis C patients.

Pectin lyase overproduction by Penicillium griseoroseum mutants resistant to catabolite repression

Abstract Expression of pectinolytic genes is regulated by catabolic repression limiting the production of pectin lyase (PL) if the natural inducer, pectin, is missing from the growth medium. Here, we report the isolation of Penicillium griseoroseum mutants resistant to 2-deoxy-d-glucose (DG) that show resistance to catabolite repression and overproduce PL. Three spontaneous and nine UV-induced mutants were obtained. Some mutants produced sectors (segments morphologically different) that were also studied. The mutants were analyzed for pectinases production on pectinase-agar plates and five mutants and two sectors showing larger clearing zones than the wild type were selected for quantitative assay. Although PL production higher than the wild type has been found, phenotype instability was observed for most of the mutants and, after transfers to nonselective medium, the DG resistance was no longer present. Only mutants M03 and M04 were stable maintaining the DG-resistance phenotype. When growing for 120 h in liquid medium containing glucose with or without pectin, both mutants showed higher PL production. In the presence of glucose as sole carbon source, the mutant M03 produced 7.8-fold more PL than the wild type. Due its phenotypic stability and PL overproduction, the mutant M03 presents potential for industrial applications.

Is a non-synonymous SNP in the HvAACT1 coding region associated with acidic soil tolerance in barley?

Abstract The barley HvAACT1 gene codes for a citrate transporter associated with tolerance to acidic soil. In this report, we describe a single nucleotide polymorphism (SNP) in the HvAACT1 coding region that was detected as T-1,198 (in genotypes with lower root growth on acidic soil) or G-1,198 (greater root growth) and resulted in a single amino acid change (L/V-172). Molecular dynamic analysis predicted that HvAACT1 proteins with L or V-172 were stable, although the substitution led to structural changes within the protein. To evaluate the effect of the SNP on tolerance to acidic soil, barley accessions were separated into haplotypes based on the presence of a 1 kb insertion in the HvAACT1 promoter and a 21 bp insertion/deletion. These markers and the SNP-1,198 allowed the identification of five haplotypes. Short-term soil experiments showed no difference in root growth for most of the accessions containing the 21 bp insertion and T or G-1,198. In contrast, genotypes showing both the 21 bp deletion and G-1,198, with one of them having the 1 kb insertion, showed greater root growth. These results indicate that the SNP was not advantageous or deleterious when genotypes from the same haplotype were compared. The occurrence of the SNP was highly correlated with the 21 bp insertion/deletion that, together with the 1 kb insertion, explained most of the barley tolerance to acidic soil.

Reticular pattern detection in dermoscopy: an approach using Curvelet Transform

Abstract Introduction Dermoscopy is a non-invasive in vivo imaging technique, used in dermatology in feature identification, among pigmented melanocytic neoplasms, from suspicious skin lesions. Often, in the skin exam is possible to ascertain markers, whose identification and proper characterization is difficult, even when it is used a magnifying lens and a source of light. Dermoscopic images are thus a challenging source of a wide range of digital features, frequently with clinical correlation. Among these markers, one of particular interest to diagnosis in skin evaluation is the reticular pattern. Methods This paper presents a novel approach (avoiding pre-processing, e.g. segmentation and filtering) for reticular pattern detection in dermoscopic images, using texture spectral analysis. The proposed methodology involves a Curvelet Transform procedure to identify features. Results Feature extraction is applied to identify a set of discriminant characteristics in the reticular pattern, and it is also employed in the automatic classification task. The results obtained are encouraging, presenting Sensitivity and Specificity of 82.35% and 76.79%, respectively. Conclusions These results highlight the use of automatic classification, in the context of artificial intelligence, within a computer-aided diagnosis strategy, as a strong tool to help the human decision making task in clinical practice. Moreover, the results were obtained using images from three different sources, without previous lesion segmentation, achieving to a rapid, robust and low complexity methodology. These properties boost the presented approach to be easily used in clinical practice as an aid to the diagnostic process.

On the geometric modulation of skin lesion growth: a mathematical model for melanoma

Abstract Introduction Early detection of suspicious skin lesions is critical to prevent skin malignancies, particularly the melanoma, which is the most dangerous form of human skin cancer. In the last decade, image processing techniques have been an increasingly important tool for early detection and mathematical models play a relevant role in mapping the progression of lesions. Methods This work presents an algorithm to describe the evolution of the border of the skin lesion based on two main measurable markers: the symmetry and the geometric growth path of the lesion. The proposed methodology involves two dermoscopic images of the same melanocytic lesion obtained at different moments in time. By applying a mathematical model based on planar linear transformations, measurable parameters related to symmetry and growth are extracted. Results With this information one may compare the actual evolution in the lesion with the outcomes from the geometric model. First, this method was tested on predefined images whose growth was controlled and the symmetry known which were used for validation. Then the methodology was tested in real dermoscopic melanoma images in which the parameters of the mathematical model revealed symmetry and growth rates consistent with a typical melanoma behavior. Conclusions The method developed proved to show very accurate information about the target growth markers (variation on the growth along the border, the deformation and the symmetry of the lesion trough the time). All the results, validated by the expected phantom outputs, were similar to the ones on the real images.

Origin and antimeric distribution of the femoral nerves in New Zealand rabbits / Origen y distribución antimérica del nervio femoral en conejos Nueva Zelanda

The origin and distribution of the femoral nerves in both antimeres were studied in 30 New Zealand rabbits (15 males and 15 females). The specimens were collected after natural death and fixed with 10% formaldehyde solution. In males, the femoral nerve originated from the ventral branches of the fourth, sixth and seventh lumbar spinal nerves in seven animals (46.67%), in two animals (13.33%) from the ventral branches of the fifth and sixth lumbar spinal nerves, in one animal (6.67%) from the ventral branch of the fifth lumbar spinal nerve, in three animals (20%) from the ventral branches of the fifth, sixth and seventh lumbar spinal nerves, in one animal (6.67%) from the ventral branches of the fourth and fifth lumbar spinal nerves, and in one animal (6.67%) from the ventral branches of the fifth and seventh lumbar spinal nerves. In females, the femoral nerve originated from the ventral branches of the fourth, sixth and seventh lumbar spinal nerves in four animals (26.67%), in two cases (13.33%) from the ventral branches of the fifth and sixth lumbar spinal nerves, in one animal (6.67%) from the ventral branch of the fifth lumbar spinal nerve, in three animals (20%) from the ventral branches of the sixth and seventh lumbar spinal nerves, in four animals (26.67%) from the ventral branches of the fifth, sixth and seventh lumbar spinal nerves and in one animal (6.67%) from the ventral branches of the fourth and seventhlumbar spinal nerves. In all animals the femoral nerves were distributed in different branches to the major and minor psoas, femoral quadriceps, sartorius and pectinius muscles.

Se estudió el origen y distribución del nervio femoral de ambos antímeros en 30 conejos neozelandeses, 15 machos y 15 hembras. Los animales fueron recolectados después de su muerte natural y se fijaron en formaldehído al 10%. En los machos, el nervio femoral se originó a partir de los ramos ventrales del cuarto, sexto y séptimo nervios espinales lumbares en siete casos (46,67%); en tres casos (20%) desde los ramos ventrales del quinto, sexto y séptimo nervios espinales lumbares; en dos casos (13,33%) desde los ramos ventrales del quinto y sexto nervios espinales lumbares, mientras que en tres animales (n=1 respectivamente), desde los ramos ventrales del quinto nervio espinal lumbar (6,67%), los ramos ventrales del cuarto y quinto nervios lumbares espinales (6,67%) y desde los ramos ventrales del quinto y séptimo nervios espinales lumbares. En las hembras, el nervio femoral se originó a partir de los ramos ventrales del cuarto, sexto y séptimo nervios espinales en cuatro casos (26,67%); en otros cuatro casos (26,67%) desde los ramos ventrales del quinto, sexto y séptimo nervios espinales lumbar, en tres casos (20%) desde los ramos ventrales del sexto y séptimo nervios espinales lumbares, en dos casos (13,33%) desde los ramos ventrales del quinto y sexto nervios espinales, y en dos animales (n=1, respectivamente) procedían desde los ramos ventrales del quinto nervio espinal lumbar (6,67%) y de los ramos ventrales del cuarto y séptimo nervios espinales lumbares (6,67%). Los nervios femorales en todos los animales estaban distribuidos en diversos ramos de los músculos psoas mayor y menor, cuádriceps femoral sartorios y pectinatos.

Infecções multirresistentes por Staphylococcus aureus: Tratamento e profilaxia / Multidrug-resistant Staphylococcus aureus infections: treatment and prophylaxis

O gênero Staphylococcus constitui-se por bactérias esféricas, chamadas de cocos, sendo que à microscopia apresentam-se agrupadas em "cachos de uva". O Staphylococcus aureus, apesar de fazer parte da microbiota humana normal, constitui-se como a espécie de bactéria mais virulenta e uma das responsáveis por infecções hospitalares e/ou adquiridas na comunidade, devido à sua disseminação intra-hospitalar sem dificuldades, somada à extraordinária capacidade de adquirir resistência a alguns antimicrobianos. A necessidade de controle das infecções causadas por S. aureus ganha ênfase devido à extensão do número de ocorrências de infecções hospitalares e à imprescindibilidade do controle dos surtos. Portanto, a resistência adquirida aos antimicrobianos se torna preocupante pelo seu uso clínico indiscriminado...

The Staphylococcus genus is constituted by spherical bacteria, called cocci, and microscopy are shown grouped into "clusters of grapes". S. aureus, despite being part of the normal human microbiota was established as the most virulent species of bacteria and one of those responsible for hospital and/or community-acquired infections due to their hospital spread smoothly added to the extraordinary ability to acquire resistance to certain antibiotics. The need for the control of infections caused by S. aureus gains emphasis due to the extension of the number of occurrences of nosocomial infections and the indispensability of the control of outbreaks. Therefore, the acquired resistance to antimicrobials is very worrying for their widespread clinical use...

The testis of the mice C57/BL6 offspring in adulthood have alterations due to maternal caffeine consumption

To investigate the effects of the maternal caffeine consumption during pregnancy to adult male testis mice offspring. METHODS: Twenty pregnant mice were divided into control group (c) and caffeine group (cf). dams received daily saline or 20 mg/kg of caffeine subcutaneously. Male offspring were monitored daily until 13th week. The testis were used to evaluate both the proliferation (pcna) and apoptosis (bax); leptin receptor (ob-r); aromatase; follicle stimulating hormone (fshr), luteinizing hormone (lhr) and androgen receptors (ar); steroidogenic acute regulatory protein (star); vascular endothelial growth factor (vegf) and estrogen receptors (erα and erβ) by western blotting. Serum concentrations of testosterone, estradiol and leptin were measured. RESULTS: There was a significant reduction in food intake and the body mass gain (p<0.05) in the cf ; pcna (p=0.01), fshr (p=0.02), star (p=0.0007), vegf (p=0.009), ar (p=0.03) in the cf. while an increase were note in bax (p=0.01), ob-r (p=0.02), lhr (p=0.04) and in the aromatase (p=0.03) in the cf. only erα and erβ were not changed by maternal caffeine. The serum testosterone levels in the cf offspring were 90% lower than in the c offspring (p=0.04). CONCLUSION: Maternal caffeine consumption has a role and alters the testis of the offspring in adulthood.

Interferon-induced depression in patients with hepatitis C: an epidemiologic study / Depressão induzida por interferon em pacientes com hepatite C: um estudo epidemiológico

Objective To assess the incidence rate and severity of depressive symptoms in different time points (12, 24 and 48 weeks) in Brazilian patients with HCV treated with PEG IFN plus ribavirin. Methods We conducted an observational prospective study using the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results Fifty patients were included. The assessments with either scale showed the highest score of depressive symptoms in the 24th week of treatment; the mean BDI score before treatment was 6.5 ± 5.3 and the mean CES-D was 10.9 ± 7.8. After 24 weeks, the mean BDI was 16.1 ± 10.2 and mean CES-D was 18.6 ± 13.0; 46% were diagnosed with depression according to combined BDI and CES-D scores. The somatic/psychomotor subscales were highly correlated with overall scale scores . Subjects with history of substance and alcohol abuse had higher risk for IFN-induced depression. Conclusion Treatment with PEG IFN was associated with a high incidence rate of depressive symptoms in this sample of Brazilian patients, as measured by CES-D and BDI. Alcohol and substance abuse increase the risk of PEG IFN-induced depression. .

Objetivo Avaliar a incidência e a gravidade de sintomas depressivos em diferentes intervalos (12, 24 e 48 semanas) em pacientes brasileiros com HCV tratados com PEG IFN mais ribavirina. Métodos Foi feito um estudo prospectivo observacional, usando o Inventário de Depressão de Beck (BDI) e a Escala de Rastreamento Populacional de Depressão (CES-D). Resultados Foram incluídos 50 pacientes. As avaliações com ambas as escalas mostraram os maiores escores de depressão na 24a semana de tratamento; o escore BDI médio antes do tratamento foi de 6,5 ± 5,3 e o CES-D foi 10,9 ± 7,8. Após 24 semanas, o BDI médio foi 16,1± 10,2 e o CES-D foi 18,6 ± 13,0; de acordo com os escores combinados BDI e CES-D, 46% receberam diagnóstico de depressão. As subescalas somática e psicomotora tiveram alta correlação. Indivíduos com história de abuso de substâncias e de álcool apresentaram maior risco de desenvolver depressão por PEG IFN. Conclusão O tratamento com PEG IFN associou-se a uma alta incidência de sintomas depressivos nessa população de pacientes brasileiros, de acordo com a BDI e CES-D. Abuso de álcool e substâncias aumentam o risco de depressão induzida por PEG IFN. .

Adenocarcinoma renal injertado en riñón poliquístico. Presentación de un caso / Renal adenocarcinoma implanted in kidney polycystic. Case presentation

Introducción: el carcinoma de células renales representa entre 90-95 % de los tumores malignos que afectan el riñón, siendo infrecuente su observación asociado a la enfermedad renal poliquística autosómica del adulto. Objetivo: mostrar la asociación de adenocarcinoma renal en una paciente con nefropatía poliquística del adulto de diagnóstico en edad avanzada con escasas manifestaciones clínicas y humorales. Presentación del caso: se presenta el caso clínico de una paciente de 65 años con antecedentes de poliquistosis renal que consulta por aumento de volumen del abdomen constatándose nefromegalia gigante. Se presentan los datos clínicos, humorales, imagenológicos e histológicos que permitieron su diagnóstico. Conclusiones: aunque infrecuente, debe considerarse la posibilidad de adenocarcinoma renal de células claras asociado al riñón poliquístico.

Introduction: the renal cells carcinoma represents between 90-95 % of the malignant tumors that affect the kidney being infrequent its observation associated with the autosomal polycystic kidney disease of the adult. Objetive: to show the association of renal adenocarcinoma in a patient with polycystic nephropathy of the adult of late presentation and with scarce clinical and humoral manifestations. Case Presentation: there appears the clinical case of a 65-year-old feminine patient with precedents of kidney polycystic that it consults of increase of volume of the abdomen being stated nefromegalia giant. The clinical information appears, humoral, imagenoly and histological that allowed its diagnosis. Conclusions: although infrequently should be consider the diagnostic possibility of clear cell renal adenocarcinoma associated to polycystic kidney.

Origem e Distribuição Antimérica dos Nervos Obturatórios em Caprinos Neonatos da Raça Saanen

Foram estudadas a origem e a distribuição dos nervos obturatórios, de ambos os antímeros, em 33 caprinos neonatos da raça Saanen, 22 machos e 11 fêmeas. Após morte natural, foram submetidos à fixação em solução de formaldeído a 10%. O nervo obturatório teve sua origem a partir dos ramos ventrais do quinto e sexto nervos espinhais lombares em 13 machos (59,09%) e em cinco fêmeas (45,45%), do ramo ventral do quinto nervo espinhal lombar em dois machos (9,09%), do ramo ventral do sexto nervo espinhal lombar em dois machos (9,09%) e em uma fêmea (9,09%), dos ramos ventrais do quarto e quinto nervos espinhais lombares em três machos (13,64%) e em quatro fêmeas (36,36%), dos ramos ventrais do sexto nervo espinhal lombar e primeiro nervo espinhal sacral em um macho (4,55%), dos ramos ventrais do quinto e sexto nervos espinhais lombares e primeiro nervo espinhal sacral em um macho (4,55%) e dos ramos ventrais do quarto, quinto e sexto nervos espinhais lombares em uma fêmea (9,09%). Houve participação dos nervos femorais e isquiáticos para formação do nervo obturatório O nervo obturatório cedeu em todos os animais e em ambos os antímeros, ramos variáveis para os músculos adutor, pectíneo, grácil, obturador externo e parte intrapélvica do obturador externo. Não foram observadas diferenças significativas entre as frequências da origem (p=0,49) e de ramos musculares (p=0,33) dos nervos obt

Local-scale spatial variation in diversity of social wasps in an amazonian rain forest in Caxiuanã, Pará, Brazil (Hymenoptera, Vespidae, Polistinae) / Variação na diversidade de vespas sociais em escala local numa floresta pluvial amazônica em Caxiuanã, Pará, Brasil (Hymenoptera, Vespidae, Polistinae)

Polistine wasps are important in Neotropical ecosystems due to their ubiquity and diversity. Inventories have not adequately considered spatial attributes of collected specimens. Spatial data on biodiversity are important for study and mitigation of anthropogenic impacts over natural ecosystems and for protecting species. We described and analyzed local-scale spatial patterns of collecting records of wasp species, as well as spatial variation of diversity descriptors in a 2500-hectare area of an Amazon forest in Brazil. Rare species comprised the largest fraction of the fauna. Close range spatial effects were detected for most of the more common species, with clustering of presence-data at short distances. Larger spatial lag effects could also be identified in some species, constituting probably cases of exogenous autocorrelation and candidates for explanations based on environmental factors. In a few cases, significant or near significant correlations were found between five species (of Agelaia, Angiopolybia, and Mischocyttarus) and three studied environmental variables: distance to nearest stream, terrain altitude, and the type of forest canopy. However, association between these factors and biodiversity variables were generally low. When used as predictors of polistine richness in a linear multiple regression, only the coefficient for the forest canopy variable resulted significant. Some level of prediction of wasp diversity variables can be attained based on environmental variables, especially vegetation structure. Large-scale landscape and regional studies should be scheduled to address this issue.

Vespas sociais são importantes nos ecossistemas neotropicais pela abundância e diversidade. A maioria dos inventários recentes não têm dedicado atenção aos atributos espaciais dos espécimes coletados. Dados espaciais são importantes para estudar e mitigar impactos sobre ecossistemas naturais e proteger espécies. Este artigo descreve e analisa em escala local padrões espaciais de registros de coleta, investigando também a variação espacial de descritores de diversidade numa área de 2.500 hectares de floresta amazônica no Brasil. Espécies raras constituíram a maior parte da fauna. Efeitos espaciais de curta distância foram detectados para a maioria das espécies mais comuns, com agregação de registros em distâncias até ca. 800 metros. Hiatos espaciais maiores foram identificados para algumas espécies, constituindo provavelmente autocorrelação exógena e candidatos a explicação por fatores ambientais. Nalguns casos, foram encontradas correlações significativas (ou quase) entre cinco espécies (de Agelaia, Angiopolybia e Mischocyttarus) e três variáveis ambientais estudadas: distância ao riacho mais próximo, altitude topográfica e tipo de copa da floresta. A associação desses fatores com variáveis de biodiversidade foi geralmente baixa. Quando utilizados como preditores de riqueza de Polistinae numa regressão linear múltipla, apenas o coeficiente para tipo de dossel florestal resultou significativo. Alguma predição mostra-se possível sobre variáveis de biodiversidade com base no conhecimento de condições ambientais, especialmente estrutura da vegetação. Estudos devem ser agendados para tratar do assunto em escalas espaciais mais amplas.

Collagen I and III and metalloproteinase gene and protein expression in prostate cancer in relation to Gleason score

PURPOSE: To evaluate if the expression of metalloproteinase, collagen I and III are related to Gleason score, preoperative PSA and pathological stage in prostate cancer. MATERIALS AND METHODS: Our study group included radical prostatectomy specimens of 33 patients with prostatic adenocarcinoma who underwent surgery from 2001 to 2009. Patients were divided into 3 groups: Gleason score=6 (13 patients), Gleason score=7 (10 patients), Gleason score>8 (10 patients). The control group included prostates of patients submitted to cystoprostatectomy and benign prostatic tissues adjacent to the cancer area. Specific areas of tissues were selected under microscope and further processed for collagen I and III analysis by real time PCR. In addition, 10 deparaffined sections of each group were used to evaluate collagen I, III and metalloproteinase immune expression. The results were correlated with Gleason score, preoperative PSA and pathological stage. RESULTS: We found significant difference in both collagen I and III gene expression between benign and tumoral areas in the prostate samples from Gleason score=6 (collagen I=0.4±0.2 vs 5±2.4, p<0.05; collagen III=0.2±0.06 vs 0.7±0.1, p<0.05) and Gleason score>8 (collagen I=8±3.4 vs 1.4±0.8, p<0.07; collagen III=1.8±0.5 vs 0.6±0.1, p<0.05). There was no correlation of collagen expression with Gleason score, preoperative PSA or pathological stage. There was a positive correlation between metalloproteinase expression and Gleason score (r²=0.47). CONCLUSIONS: The positive correlation between metalloproteinase expression and Gleason score suggests that metalloproteinase could be a promising factor to improve Gleason score evaluation. Its expression and regulation do not seem to be related with collagen degradation.

Parálisis diafragmática bilateral. Presentación de un caso / Bilateral diaphragmatic paralysis

La parálisis diafragmática bilateral es una entidad muy infrecuente en la clínica, debido a diferentes entidades con capacidad de lesionar el nervio frénico. El compromiso respiratorio que produce requiere cuidado especializado. Este es el primer caso reportado en nuestra literatura a consecuencia de hernias cervicales múltiples. Se presenta un caso de un paciente de 43 años, con antecedentes de salud, exatleta de alto rendimiento, que ingresó en nuestro servicio, con disnea de 5 meses de evolución, que aumentó progresivamente en intensidad hasta mantenerlo en ortopnea constante, fue estudiado exhaustivamente hasta llegar a diagnostico definido y derivarlo al servicio de Neurocirugía para su solución definitiva. La importancia del tema que se presenta es que se describe una presentación rara de parálisis diafragmática bilateral, a consecuencia de hernias discales cervicales múltiples.

Bilateral diaphragmatic paralysis is a rare condition in clinical practice due to different entities that can damage phrenic nerve. The resulting respiratory compromise requires medical special care. This is the first case reported in our medical literature caused by multiple cervical hernias. A 43 year-old patient having health history, high performance ex-athlete, admitted in the service with 5-month evolution of dyspnea which progressively increased in intensity up to maintain him in permanent orthopnea, thorough studies were conducted to the definite diagnosis and he was transferred to Neurosurgery Service to a definite solution. A rare presentation of a bilateral diaphragmatic paralysis resulting from multiple cervical hernias gives importance to the topic.