Applicability of vaginal energy-based devices in urogynecology: evidence and controversy

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Fístula enterocutánea en una hernia incisional / Enterocutaneous fistula in an incisional hernia

Introducción: Los defectos técnicos en el cierre de la laparotomía, como la utilización de suturas inadecuadas, muy apretadas o distancia incorrecta entre los puntos, presencia de cuerpos extraños, hematomas o la inclusión de un asa intestinal (pellizcamiento de esta), pueden provocar la aparición de una hernia incisional, y peor aún acompañarse de una fístula intestinal. Objetivo: Corroborar la importancia del cierre correcto y cuidadoso de la pared abdominal después de una laparotomía. Presentación del caso: Se trata de una paciente de 34 años de edad con antecedentes de tres cesáreas en un período de seis años, la última hace seis meses, que fue atendida en el Hospital Mnazi Mmoja, en Tanzania, refiriendo salida de contenido líquido amarillento a nivel de la cicatriz quirúrgica. Al examen físico se constata hernia incisional y un asa intestinal adherida a la piel con un orificio de menos de un cm por donde sale contenido intestinal amarillento. Se interviene con diagnóstico preoperatorio de hernia incisional y fístula enterocutánea; se realiza resección de 3 tres cm del íleon, anastomosis termino-terminal donde se encuentra el orificio fistuloso y hernioplastia mediante la técnica de Rives con utilización de malla de polipropileno. La evolución posoperatoria fue satisfactoria. Conclusiones: Se refuerza la afirmación que es de suma importancia el cierre correcto y cuidadoso de la pared abdominal después de una laparotomía, sobre todo si se realiza con urgencia(AU)

Introduction: In the closure of the laparotomy, technical defects such as the use of inadequate sutures, too tight or incorrect distance between stitches, the presence of foreign bodies, hematomas or the inclusion of an intestinal loop (pinching) can cause the appearance of an incisional hernia which, even worse, can be accompanied by an intestinal fistula. Objective: To corroborate the importance of the correct and careful closure of the abdominal wall after performing laparotomy. Case presentation: A 34-year-old patient with a history of three previous cesarean sections in a six-year period, the last one performed six months, was treated at the Mnazi Mmoja Hospital in Tanzania when she reported the release of a yellowish liquid content at the surgical scar level. Physical examination revealed an incisional hernia and an intestinal loop attached to the skin with a hole of less than one cm through which yellowish intestinal content was coming out. She was operated on with the preoperative diagnosis of incisional hernia and enterocutaneous fistula; a three-cm resection of the ileum, end-to-end anastomosis where the fistulous orifice was located, and hernioplasty were performed using the Rives technique with polypropylene mesh. The postoperative evolution was satisfactory. Conclusions: The assertion that correct and careful closure of the abdominal wall after laparotomy is of utmost importance, especially if it is performed urgently, is reinforced(AU)

Empiema de necesidad / Empyema of Necessity

Introducción: El empiema de necesidad o empiema necessitatis (del latín) es un hallazgo raro en la actualidad y la tuberculosis es la causa más común, sobre todo en pacientes inmunodeprimidos. Objetivo: Presentar un caso con un empiema de necesidad como complicación de la tuberculosis extrapulmonar Caso clínico: Paciente de sexo femenino de 47 años de edad, sin antecedentes de enfermedad conocidos. Ingresa por una neumonía de la base derecha y como complicación un empiema de necesidad de naturaleza tuberculosa. Es tratada de forma médica y quirúrgica, tuvo una evolución favorable. Conclusiones: El conocimiento de la epidemiología de la zona donde se diagnosticó la enferma y la medicina personalizada contribuyeron a un diagnóstico rápido y a un tratamiento médico y quirúrgico acorde a los protocolos establecidos para la tuberculosis extrapleural(AU)

Introduction: Empyema of necessity (or empyema necessitatis) is, at present, a rare finding, of which tuberculosis is the most common cause, especially in immunosuppressed patients. Objective: To present a case of empyema of necessity as a complication of extrapulmonary tuberculosis. Clinical case: 47-year-old female patient, without known history of disease, who was admitted due to pneumonia of the right base and, as a complication, an empyema of necessity of a tubercular nature. She was treated medically and surgically, and had a favorable evolution. Conclusions: Knowledge of the epidemiology of the area where the patient was diagnosed, together with personalized medical care, contributed to a rapid diagnosis, as well as to the medical and surgical treatment provided according to the protocols established for extrapleural tuberculosis(AU)

Algunas especificidades en torno al cáncer de pulmón / Some specificities about lung cancer

Introducción: El cáncer de pulmón predomina a nivel mundial, en la tercera edad de la vida y exhibe cifras bajas de supervivencia. Se realiza una búsqueda en bases bibliográficas biomédicas; se seleccionaron 25 de 58 artículos sobre el tema. Objetivos: Describir y analizar algunas características específicas del cáncer de pulmón con énfasis en aspectos epidemiológicos, etiopatogénicos y de la estadificación nodular linfática. Desarrollo: La clasificación tumor, ganglio, metástasis (TNM) para el cáncer de pulmón en su 8va versión, se publicó en 2016 y está vigente con nuevas categorías de los componentes tumor (T) y metástasis (M), así como la aparición de nuevos estadios, pero sin cambios en el componente ganglios (N); a pesar de lo cual la valoración nodular linfática del mediastino (pN) tiene implicaciones pronósticas y terapéuticas de gran importancia en los pacientes con cáncer de pulmón de células no pequeñas. Conclusiones: El cáncer de pulmón de células no pequeñas es el más frecuente y mortal a escala mundial, en una población ya envejecida, en la cual los factores moleculares, genéticos y ambientales juegan un papel en su desarrollo y son objeto de estudio, de ahí que la estadificación TNM sea de vital importancia al determinar las decisiones del tratamiento y del pronóstico. La correcta identificación de la afectación ganglionar es indispensable, puesto que, en ausencia de metástasis, marcará el pronóstico. La metodología utilizada para crear las diferentes ediciones de la clasificación TNM está en continua evolución, acorde al desarrollo científico contemporáneo(AU)

Introduction: Lung cancer is predominant worldwide, in the third age of life and exhibits low survival rates. A search is carried out in biomedical bibliographic databases; 25 of 58 articles on the topic were selected. Objectives: To describe and analyze some specific characteristics of lung cancer with an emphasis on epidemiological, etiopathogenic and lymphatic nodular staging aspects. Development: The TNM classification for lung cancer in its 8th version, was published in 2016 and is in force with new categories of components T and M, as well as the appearance of new stages but without changes in component N; Despite this, lymph node evaluation of the mediastinum (pN) has important prognostic and therapeutic implications in patients with non-small cell lung cancer. Conclusions: Non-small cell lung cancer is the most frequent and deadly worldwide, in an aging population, where molecular, genetic and environmental factors play a role in its development and continue to be the subject of studies; hence TNM staging is vital when determining treatment and prognosis decisions. The correct identification of lymph node involvement is essential, since in the absence of metastasis, it will determine the prognosis. The methodology used to create the different editions of the TNM classification is in continuous evolution, according to contemporary scientific development(AU)

Impact of bariatric surgery in patients with stress urinary incontinence / Impacto da cirurgia bariátrica em pacientes com incontinência urinária de esforço

ABSTRACT Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

RESUMO Objetivo: Examinar as variáveis epidemiológicas, antropométricas e clínicas associadas à incontinência urinária de esforço em mulheres obesas antes e após a cirurgia bariátrica e identificar fatores preditivos da resolução desse tipo de incontinência. Métodos: Estudo observacional prospectivo com mulheres de um programa de cirurgia bariátrica, realizado entre 2015 e 2016. As pacientes responderam ao International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, à Clinical Global Impression-Improvement e à Escala Visual Analógica, sendo submetidas ao exame físico e ao teste de incontinência antes e 6 meses após cirurgia bariátrica. Resultados: Completaram o estudo 43 mulheres. Houve redução de 72,7% na incontinência urinária de esforço (p=0,021). Fatores preditivos para o diagnóstico pré-operatório da incontinência urinária incluíram idade (p=0,024) e circunferência abdominal (p=0,048). Todos os sintomas urinários demonstraram melhora após perda de peso, notadamente noctúria (p=0,001) e incontinência urinária de esforço (p=0,026). A menopausa foi o fator mais crítico para predizer a persistência da incontinência urinária de esforço 6 meses após a cirurgia bariátrica (p=0,046). Os resultados relatados do International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, da Patient Global Impression of Improvement e da Escala Visual Analógica tiveram melhora significativa (p=0,012, p=0,025, p=0,002, respectivamente). Conclusão: Mulheres idosas e com maior circunferência abdominal têm maior risco de desenvolver incontinência urinária de esforço antes da cirurgia. Mulheres na menopausa são fortemente propensas a persistir com a incontinência urinária de esforço, mesmo após a perda de peso. A perda de peso após a cirurgia bariátrica melhora os sintomas de incontinência urinária de esforço e seus impactos na qualidade de vida na maioria das mulheres.

Caracterización de los pacientes operados de cáncer de pulmón de células no pequeñas / Characterization of Patients Operated on for Nonsmall-Cell Lung Cancer

RESUMEN Introducción: El tumor de pulmón de células no pequeñas es un problema de salud pública, y la primera causa de muerte por cáncer a nivel mundial. Objetivo: Describir las características epidemiológicas, clínicas e histológicas en la población de enfermos aquejados de cáncer de pulmón de células no pequeñas, así como de las técnicas de resección pulmonar y de linfadenectomías utilizadas. Métodos: Se realizó un estudio descriptivo y transversal en el Servicio de Cirugía General del Hospital Provincial "Saturnino Lora" de Santiago de Cuba, desde enero de 2009 hasta enero de 2019. La muestra aleatoria fue de 55 pacientes diagnosticados de cáncer de pulmón de células no pequeñas a los que se les realizó resección pulmonar más linfadenectomía mediastinal. Se utilizaron como medidas de resumen para caracterizar las variables, el número absoluto, el porcentaje y la media, así como la prueba de significación Ji al cuadrado de independencia para identificar su posible asociación. Resultados: Predominó el sexo femenino y el grupo etario de 55 a 64 años. El adenocarcinoma fue el tipo histológico más frecuente. El lóbulo superior izquierdo resultó el más afectado. La lobectomía pulmonar con disección ganglionar por muestreo fue la técnica quirúrgica más utilizada. Predominaron los pacientes en estadios IB y IIA de la enfermedad. Conclusión: La linfadenectomía sistemática del mediastino, permite una certera estadificación, lo que determina una mejor evaluación del tratamiento y del pronóstico en estos enfermos(AU)

ABSTRACT Introduction: Non-small cell lung tumor is a public health problem, and the leading cause of cancer death worldwide. Objective: To describe the epidemiological, clinical and histological characteristics in the population of patients suffering from non-small cell lung cancer, as well as the techniques of lung resection and lymphadenectomies used. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Service of the Provincial Hospital "Saturnino Lora" in Santiago de Cuba, from January 2009 to January 2019. The random sample consisted of 55 patients diagnosed with cell lung cancer non-small patients who underwent lung resection plus mediastinal lymphadenectomy. The absolute number, the percentage and the mean were used as summary measures to characterize the variables, as well as the Chi-squared significance test of independence to identify their possible association. Results: The female sex and the age group 55 to 64 years predominated. Adenocarcinoma was the most frequent histological type. The left upper lobe was the most affected. Pulmonary lobectomy with sampling lymph node dissection was the most widely used surgical technique. Patients in stages IB and IIA of the disease predominated. Conclusion: Systematic lymphadenectomy of the mediastinum allows an accurate staging, which determines a better evaluation of treatment and prognosis in these patients(AU)

Fístula quilosa posoperatoria / Postoperative chylous fistula

Introducción: La fístula quilosa posoperatoria debida a lesión iatrogénica del conducto torácico es una complicación infrecuente y grave de la cirugía de cabeza y cuello. Objetivo: Describir las opciones de tratamiento de la fístula quilosa cervical posquirúrgica. Caso clínico: Se presenta un paciente de 18 años de edad con diagnóstico de linfangioma quístico de la región lateral izquierda del cuello, intervenido en el Servicio de Cirugía General del Hospital "Mnazi Mmoja", de Zanzíbar, Tanzania. Durante la evolución posoperatoria se constató una fístula quilosa de bajo débito la cual resolvió mediante tratamiento médico. El enfermo egresó curado a los 28 días después de la intervención quirúrgica. Conclusión: El tratamiento conservador es efectivo en la mayoría de las fístulas quilosas cervicales de bajo débito, mientras que en las de débito alto la cirugía ofrece una rápida resolución, aunque no existe consenso en torno al momento ideal para realizarla(AU)

Introduction: Postoperative chylous fistula due to iatrogenic thoracic duct injury is an infrequent and serious complication of head and neck surgery. Objective: To describe the treatment options of postoperative cervical chylous fistula. Clinical case: It was presented an 18-year-old patient with diagnosis of cystic lymphangioma of the left lateral region of the neck, which was removed in the General Surgery Service of the National Hospital Mnazi Mmoja of Zanzibar, Tanzania. During the postoperative evolution, a low-output chylous fistula was found and resolved by medical treatment. The patient withdrew cured at 28 days after the surgical intervention. Conclusion: Conservative treatment is effective in the majority of low-out put cervical chylous fistulas, while in high-debit, surgery offers a rapid resolution, although there is no consensus about the ideal time to perform it(AU)

Consideraciones en torno a los tumores del mediastino / Considerations about mediastinal tumours

Introducción. El desarrollo de las imágenes diagnósticas hizo posible el diagnóstico topográfico de los tumores de mediastino; sin embargo, aún con los avances actuales de la cirugía, la anestesiología y la reanimación, el acceso quirúrgico a ese espacio medio de la caja torácica continúa siendo el gran reto que enfrentan los cirujanos torácicos. Objetivo. Profundizar en los diferentes aspectos cognoscitivos actualizados sobre los tumores mediastinales.Métodos. Búsqueda documental digital en bases de datos: Scielo, Lilacs, Web of Science, PubMed, realizada en enero de 2019, de publicaciones sobre el tema en la presente centuria. Resultados. Las neoplasias mediastinales son poco frecuentes, pueden aparecer a cualquier edad, aunque son más frecuentes entre la tercera y quinta décadas, y la mayoría se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Los tumores malignos del mediastino son poco frecuentes, pero los benignos constituyen un desafío diagnóstico para radiólogos y patólogos. En las neoplasias malignas se identifica una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. Conclusiones. El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, si bien la tomografía computarizada, asociada o no a la biopsia percutánea, es el estándar de oro para el diagnóstico preoperatorio. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico, están condicionados por la localización y el tamaño del tumor en el mediastino

Introduction. The development of diagnostic images made the topographic diagnosis of mediastinal tumors possible; however, even with current advances in surgery, anesthesiology, and resuscitation, surgical access to this mid-rib cage space continues to be the great challenge faced by chest surgeons.Objective. To deepen in the different updated cognitive aspects about mediastinal tumors.Methods. Digital documentary search in databases: Scielo, Lilacs, Web of Science, and PubMed, performed in January 2019, of publications on the subject in the present century.Results. Mediastinal neoplasms are rare, they can appear at any age, although they are most common between the third and fifth decades, and most are discovered incidentally on a routine chest radiograph in asymptomatic patients. Malignant tumors of the mediastinum are rare, but benign tumors pose a diagnostic challenge for radiologists and pathologists. In malignant neoplasms, a wide range of histological varieties is identified, attributable to the characteristics of the affected organ.Conclusions. The definitive diagnosis is generally established by postoperative histopathological study, although computed tomography, associated or not with percutaneous biopsy, is the gold standard for preoperative diagnosis. The selection of the entry route to the thorax, as well as the surgical procedure, are conditioned by the location and size of the tumor in the mediastinum

Os elementos de um sistema educacional inclusivo visto da perspectiva dos professores / Los elementos de un sistema educacional inclusivo desde la perspectiva de los profesores / The elements of an inclusive educational system as seen from the perspective of teachers

La educación inclusiva es el derecho que garante la participación de todos los alumnos, así como su participación y también la posibilidad de progresar dentro del sistema educacional. A lo largo del estudio, daremos una breve mirada en ese proceso, que sigue en marcha, abordando los aspectos más relevantes en relación a la legislación y literatura referente a este tema. El objetivo principal es proponer una escala de medida del nivel de inclusión y conocer cuáles son los aspectos fundamentales para realizar una inclusión verdadera. El aspecto más nuevo incluido en este estudio está relacionado a los resultados de la investigación empírica, que empresta una estructura científica para ese proceso. Proponemos una escala de mensuración para la educación inclusiva (CSEI) que - llevando en consideración la opinión de 133 profesores - incluye 10 factores considerados esenciales para llegarse a una conclusión confiable. Además de eso, usando modelos de regresión causal y linear, podemos ilustrar el hecho de que el conocimiento relativo a la inclusión es más importante que el conocimiento relativo a la deficiencia. Además de eso, la mejora en las medidas de integra, así como la corrección de deficiencias en la enseñanza, son aspectos fundamentales a ser considerados para cumplirse la educación inclusiva.

A educação inclusiva é o direito que garante a participação de todos os alunos, assim como a sua participação e também a possibilidade de progredirem dentro do sistema educacional. Ao longo do estudo a seguir, daremos uma breve olhada nesse processo, ainda em andamento, abordando os aspectos mais relevantes em relação à legislação e literatura referente a este assunto. O objetivo principal é propor uma escala de medida do nível de inclusão e conhecer quais são os aspectos fundamentais para realizar uma inclusão verdadeira. O aspecto mais novo incluído neste estudo está relacionado aos resultados da pesquisa empírica, que empresta uma estrutura científica para esse processo. Propomos uma escala de mensuração para a educação inclusiva (CSEI) que - levando em consideração a opinião de 133 professores - inclui 10 fatores considerados essenciais para se chegar a uma conclusão confiável. Além disso, usando modelos de regressão causal e linear, podemos ilustrar o fato de que o conhecimento relativo à inclusão é mais importante do que o conhecimento relativo à deficiência. Além disso, a melhoria nas medidas de integração, bem como a correção de deficiências no ensino, são aspectos fundamentais a serem considerados para se atingir a educação inclusiva.

Inclusive education is the right which guarantees the attendance of all students, as well as their participation and also the possibility for them to progress, within the educational system. Throughout the following study we will take a brief look at this process, still in progress, dealing with the most relevant aspects with regards to legislation and literature relative to this subject. The main objective is to propose a scale of measurement of the level of inclusion and to know what are the fundamental aspects to carry out a true inclusion. The most novel aspect included in this study is related to the results of empirical research, which lends a scientific framework for this process. We propose a measurement scale for inclusive education (CSEI) which - taking into consideration the opinion of 133 teachers - includes 10 factors deemed to be essential in order to reach a reliable conclusion. Furthermore, using causal and linear regression models, we can illustrate the fact that knowledge relative to inclusion is more important than that knowledge relative to disability. Also, the improvement in measures for integration, as well as the correction of deficiencies in teaching, are fundamental aspects to consider in order to achieve inclusive education.

Leukotriene B4 in equine asthma syndrome: what do we know so far? / Leucotrieno B4 na síndrome asmática equina: o que sabemos até o momento?

The term "equine asthma syndrome" (EAS) was recently proposed due to the resemblance of the equine disease to human asthma. Leukotrienes cause constriction of the bronchi, especially in the lower airways and increase mucus secretion in the respiratory system. Leukotriene B4 (LTB4) has been discovered as a strong chemotactic factor, which plays a role in neutrophil migration. The immunologic background of EAS remains not fully elucidated despite many studies on the pathogenesis. This study aimed to evaluate the LTB4 concentration in the bronchoalveolar lavage fluid (BALF) of horses with and without pulmonary inflammatory disease. Thirty-five mixed breed horses were studied and LTB4 was determined by using specific ELISA Kit. The horses were grouped by 2 different criteria for statistical analysis of data: 1) according to the values for BALF citology and 2) according to the detection of LTB4 in BALF. There was significant difference of effect of age on the LTB4 detection in equine BALF. Younger animals were the majority where it was possible to detect LTB4 values in LBA. In conclusion, there was an effect of age on the detection of LTB4 in equine BALF, where LTB4 levels were more easily detected in younger animals than older animals and the results of this study raise the possibility of considering future studies with the objective of establishing the real role and the best moment to detect LTB4 in BALF of the equine asthma syndrome.(AU)

Recentemente, o termo "síndrome da asma equina" (SAE) foi proposto devido à semelhança da doença equina à asma humana. Os leucotrienos causam constrição dos brônquios, especialmente nas vias aéreas posteriores e aumentam a secreção de muco no sistema respiratório. O leucotrieno B4 (LTB4) foi descoberto como um forte fator quimiotático, que desempenha um papel na migração de neutrófilos. O fundo imunológico do SAE permanece não completamente elucidado apesar de muitos estudos sobre a patogênese. Este estudo teve como objetivo avaliar a concentração de LTB4 no lavado broncoalveolar (LBA) de equinos com e sem doença inflamatória pulmonar. Trinta e cinco cavalos de raças mistas foram estudados e o LTB4 foi determinado usando o kit ELISA específico. Os animais foram agrupados por dois critérios diferentes para análise estatística dos dados: 1) de acordo com os valores para citologia do LBA e 2) de acordo com a detecção do LTB4 no LBA. Houve diferença significativa do efeito da idade na detecção do LTB4 no LBA equino. Os animais mais jovens foram a maioria onde foi possível detectar os valores de LTB4 no LBA. Em conclusão, houve um efeito da idade na detecção de LTB4 em LBA equino, onde os níveis de LTB4 foram mais facilmente detectados em animais jovens do que em animais mais velhos e foi possível detectar a concentração de LTB4 no LBA equino e os resultados deste estudo levantam a possibilidade de considerar futuros estudos com o objetivo de estabelecer o real papel e o melhor momento para detectar LTB4 no LBA da síndrome asmática equina.(AU)

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients

Abstract INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up

ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.

Agenesia del tronco celíaco, una rara e importante variante anatómica. Presentación de dos casos y revisión de tema / Celiac Trunk Agenesis, a Rare and Important Anatomical Variant. A Report of Two Cases and Topic Review

Las variantes anatómicas del tronco celíaco son muy comunes y normalmente asintomáticas. Es importante conocer las diferentes configuraciones para evitar potenciales complicaciones en pacientes que se someten a un procedimiento diagnóstico o terapéutico. La agenesia del tronco celíaco es una variante anatómica muy rara, descrita por unos pocos autores. Se presentan dos casos de agenesia del tronco celíaco diagnosticados accidentalmente mediante tomografía computarizada. Las arterias hepática común y esplénica adquieren una "configuración en U" sin origen en la aorta abdominal, y con una arcada colateral pancreato-duodenal que suple al hígado y al bazo. En este artículo se describen los hallazgos radiográficos de la agenesia del tronco celíaco en ambos casos y se hace una revisión de tema sobre las variaciones del tronco celíaco.

Anatomical variations of the celiac trunk are very common and usually asymptomatic. It is important to know these different configurations to avoid potential complications in patients undergoing a diagnostic or surgical procedure. Celiac trunk agenesis is a very rare anatomical configuration, reported by a few authors. We show two cases of celiac trunk agenesis incidentally diagnosed by computerized tomography (CT). Common hepatic and splenic arteries acquire a "U-shape" that does not arise from the abdominal aorta, and a collateral pancreatic-duodenal arcade supplies the liver and spleen. In this article we describe the imaging findings of celiac trunk agenesis in both cases and made a literature review on celiac trunk variations.

Incidência, tipo e natureza das lesões dos atletas do Rúgbi São José na temporada de 2014 / Incidence, type and nature of injuries on athletes of Rugby São José at the 2014 season / Incidencia, tipo y naturaleza de las lesiones de los atletas de Rugby São José en la temporada 2014

INTRODUÇÃO: O rúgbi será incluído novamente como esporte olímpico nos Jogos Olímpicos Rio 2016 e seus atletas apresentam alta incidência de lesões em virtude das características do esporte. OBJETIVO: Reportar a incidência, local, natureza, tratamento das lesões e o tempo de afastamento de atletas do Rúgbi São José na temporada de 2014 em função das lesões. MÉTODOS: Foi realizado um estudo transversal com 62 atletas do rúgbi, sendo identificados como principais fatores de risco para lesões na temporada de 2014 a existência de lesões prévias, idade, tempo de prática do rúgbi, IMC elevado, posição de jogo, horas de treino semanal e frequência de treinamento em academia. RESULTADOS: As principais lesões encontradas foram lesões articulares nos membros inferiores. CONCLUSÃO: Encontramos alta incidência de lesões nos atletas do Rúgbi São José, com predomínio das lesões articulares dos membros inferiores, sendo os principais fatores de risco a idade mais avançada, maior tempo de prática do rúgbi, IMC elevado, maior tempo de treino semanal e hábito de frequentar academia de musculação, além de presença de lesões prévias e a posição de jogo na "linha". .

INTRODUCTION: Rugby will be included back as an Olympic sport in the Olympics Rio 2016 and athletes show a high incidence of injuries due to the sports' characteristics. OBJECTIVE: To report the incidence, location, nature, treatment of injuries and the time of withdrawal from sports due to injuries of Rugby São Jose athletes in the 2014 Season. METHODS: We conducted a cross-sectional study with 62 rugby athletes identifying the main risk factors for injuries in the 2014 season, the existence of previous injuries, age, time practicing rugby, high BMI, playing position, hours of weekly training and gym training habits. RESULTS: The main injuries found were in lower limbs joints. CONCLUSION: We found a high incidence of injuries in Rugby São José athletes, with a predominance of joint injuries at the lower limbs, the main risk factors being: age, time playing rugby, high BMI, highest weekly workout frequency and gym training habits, besides the presence of previous injuries and playing in the "in line" position. .

INTRODUCCIÓN: El rugby será un deporte olímpico en Rio 2016 y sus atletas poseen una alta incidencia de lesiones debido a las características del deporte. OBJETIVO: Reportar la incidencia, el local, la naturaleza, el tratamiento y el momento de alejamiento de las lesiones en los atletas de Rugby São José en la temporada 2014. MÉTODOS: Estudio transversal realizado con 62 atletas de rugby, siendo identificados como factores principales de riesgo para lesiones en la temporada 2014, la existencia de lesiones previas, edad, tiempo de rugby, IMC elevado, posición de juego, horas de entrenamiento semanal y frecuencia en gimnasio. RESULTADOS: Las principales lesiones encontradas fueron las articulaciones en los miembros inferiores. CONCLUSIÓN: Se encontró alta incidencia de lesiones en atletas de Rugby São José, con predominio de lesiones articulares de los miembros inferiores, siendo los principales factores de riesgo la mayor edad, más tiempo de rugby, IMC elevado, mayor tiempo de entrenamiento semanal y hábito de frecuentar gimnasio de musculación, además de la presencia de lesiones anteriores y la posición de juego en la "línea". .

¿Pancreatitis con infartos óseos y paniculitis: es correcto el síndrome PPP (pancreatitis, paniculitis, poliartritis)? Presentación de 2 casos clínicos y revisión de la literatura / Pancreatitis with bone infarctions and panniculitis, is this really the PPP (pancreatitis, panniculitis, polyarthritis) syndrome? Presentation of 2 clinical cases and literature review

El síndrome pancreatitis, paniculitis y poliartritis (PPP) es producido, principalmente, por laliberación sistémica de las enzimas pancreáticas, que ocasiona fundamentalmente afectacióndel tejido celular subcutáneo (paniculitis primaria) y del espacio periarticular (artritis),siendo menos frecuente la afectación de la médula ósea. Presentamos 2 casos de síndromePPP con artritis clínica, extensos infartos óseos y paniculitis adyacente. En la literaturarevisada, existen pocos casos evaluados mediante resonancia magnética. En los casosestudiados, la artritis sindrómica correspondía con infartos óseos y necrosis avascular. Lanecrosis ósea extensa puede producir disrupción cortical y paniculitis secundaria, que esdifícil de diferenciar de la artritis...

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula

Purpose The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. Materials and Methods: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. Results The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts. .