Tratamento da flacidez músculo aponeurótica acentuada da parede abdominal, experiência de 26 anos / Treatment of marked abdominal wall musculoaponeurotic flaccidity: 26 years of experience

Realizamos uma análise de quais são os elementos responsáveis pelo sustento e formato abdominal, determinando assim, que é devido a uma excessiva flacidez musculoaponeurótica de origem primária, à qual promove uma incapacidade do suporte da parede abdominal e pode estar relacionada a fatores predisponentes. Para esses casos específicos, desenvolvemos um tratamento propondo a colocação da tela e apresentando nossa experiência. Apresentamos esta série de casos de experiência em 26 anos. Onde 15 pacientes foram tratados com abdominoplastia primária e secundária. O reforço da parede abdominal foi realizado através da colocação de tela de polipropileno no plano submuscular com pontos em U na fáscia transversalis, buscando-se fortalecer o músculo e a fáscia transversa. Os resultados foram satisfatórios a longo prazo. Obtendo resolução das protuberâncias abdominais e restaurando a harmonia dos músculos. Apenas duas complicações ocorreram, que foram a presença de dor crônica localizada no abdome tratada com infiltrações de esteroides e fístula umbilical precoce de resolução rápida espontânea, independente da proposta.

We investigated the causative factors of abdominal support and shape and found that excessive musculoskeletal flaccidity of primary origin causes an inability to support the abdominal wall and may be associated with the predisposing factors. For such cases, we developed a treatment consisting of the placement of a subcutaneous mesh. Here, we present our experience with this treatment. We present a case series of 15 patients in our 26 years of experience who were treated with primary and secondary abdominoplasties. The abdominal wall was reinforced by placing a polypropylene mesh in the submuscular plane with U-stitches in the transversalis fascia, aiming at strengthening the muscle and transverse fascia. The results were satisfactory in the long term. Abdominal bulges were repaired, and muscle harmony was restored. Only two complications occurred: chronic pain localized in the abdomen, which was treated with steroid infiltrations, and an early umbilical fistula with spontaneous and rapid resolution, regardless of the proposal.

Treatment of swine wastewater using anaerobic filters with different types of support media / Tratamento de águas residuárias de suinocultura em filtros anaeróbios com diferentes tipos de meio suporte

Research using anaerobic filters as alternative materials to gravel becomes fundamental, especially if they are low cost, accessible and have high efficiency in the treatment of swine wastewater. This study aimed to evaluate the efficiency of anaerobic filters with different types of support media, as an alternative to gravel, in the treatment of swine wastewater. We carried out the experiment in a completely randomized design. The treatments were composed of anaerobic filters with four different media (gravel, bamboo, luffa sponge and foam), three replications in a time-repeated measurements scheme (0, 60, 120, 180 and 240 days post-filter establishment). To determine the efficiency of removal by the filters, we performed analysis of turbidity, total solids, biochemical oxygen demand (bod), total n and total p in the affluent to and effluent from the filters. Among the alternative media, bamboo presented an efficiency of removal of the evaluated attributes similar and, in most cases, superior to gravel. From 60 to 180 days of filter operation, the luffa sponge remained with high turbidity and total solids removals, with the greatest decrease at 240 days of operation. After two months of filter operation, the alternative support media exhibited bod and total n removal similar to that of gravel. At 240 days of operation, the filters containing luffa sponge and bamboo showed the highest total p removal.

Pesquisas utilizando filtros anaeróbios com materiais alternativos à brita tornam-se fundamentais, principalmente se forem de baixo custo, acessíveis e possibilitem elevada eficiência no tratamento de águas residuárias de suinocultura. Objetivou-se avaliar a eficiência de filtros anaeróbios com diferentes tipos de meio suporte, alternativos à brita, no tratamento de águas residuárias da suinocultura. O experimento foi realizado em delineamento inteiramente ao acaso, sendo os tratamentos compostos por filtros anaeróbios com quatro diferentes meios suportes (brita, bambu, bucha vegetal e espuma), três repetições em esquema de medidas repetidas no tempo, (0, 60, 120, 180 e 240 dias pós-estabelecimento dos filtros). Para a determinação da eficiência de remoção nos filtros, análises de turbidez, sólidos totais, Demanda Bioquímica de Oxigênio (DBO), N-total e P-total foram realizadas no afluente e no efluente aos filtros. Dentre os meios suportes alternativos, o bambu apresentou eficiências de remoção dos atributos avaliados semelhantes e, na maioria das vezes, superiores à brita. Dos 60 aos 180 dias de operação dos filtros, a bucha vegetal manteve-se com elevadas remoções de turbidez e sólidos totais, tendo o maior decréscimo, aos 240 dias de operação. Após 2 meses de operação dos filtros, os meios suportes alternativos apresentaram remoções de DBO e N-totalsemelhantes à brita. Aos 240 dias de operação, os filtros contendo bucha vegetal e bambu apresentaram as maiores remoções de P-total.

Cleft lip secondary repair: evaluation and description of the method of orbicularis oris three uints / 中华医学美学美容杂志

Objective Secondary deformities are common in people born with unilateral cleft lip and palate.In recent years,more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy.The authors present a new method of orbicularis oris repair in secondary cleft lip repair.Methods From July 2009 to December 2011,24 patients underwent this procedure in the authors' department.Muscle reconstruction was divided into three units that dealed with the nasal base,white lip and red lip.Common anatomic pathologies including the displacement of upper lip,flared ala,blunted ala-facial groove,depressed nasal floor,lateral bulge,lack of philtrum column,free border deficiency and unapparent vermilion tubercle were corrected in a single operation.Results The average follow-up period was 16.79±6.23 months.No major complications occurred.All the patients were satisfied with their nasolabial appearance.Conclusions "Three-unit" muscle repair has found to be effective and practical in secondary repair.Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure.

Experiências brasileiras com wetlands construídos aplicados ao tratamento de águas residuárias: parâmetros de projeto para sistemas horizontais / Brazilian experiences with constructed wetlands applied to wastewater treatment: design parameters for horizontal systems

A utilização no Brasil de sistemas tipo wetlands construídos no tratamento de águas residuárias iniciou no ano de 1980, intensificando-se a partir do ano 2000. O objetivo deste trabalho é apresentar um estado da arte da aplicação no Brasil dos wetlands construídos de escoamento subsuperficial de fluxo horizontal (WCFH), identificando parâmetros de projeto e dados operacionais. Aborda-se, inicialmente, uma classificação para os wetlands construídos, seguido dos parâmetros de projeto e operação dos WCFH, destacando os diferentes critérios de dimensionamento, tais como os modelos oriundos da cinética de primeira ordem aplicável aos reatores tipo pistão, a relação de área per capita, o carregamento orgânico superficial e a taxa hidráulica, bem como a composição das unidades de tratamento e as macrófitas empregadas.

The implementation of constructed wetlands for wastewater treatment in Brazil has started in the eighties, being intensified since the year 2000. The aim of this study is to present the state of art of implementation of horizontal sub-superficial flow constructed wetlands (HFCW) in Brazil, focusing on the identification of design parameters and operational data. Initially a classification for constructed wetlands is given, followed by design parameters and operational conditions for HFCW, highlighting different project criteria, e.g. models from first order kinetics for tubular piston reactors, the relation of superficial area per person, the organic superficial loading and the hydraulic loading, as well as the composition of units and macrophytes utilised.

¿Es el fin de la anticoagulación con la oclusión percutánea de la orejuela izquierda en fibrilación auricular? / Is the end of anticoagulation with the percutaneous left atrial appendage occlusion in atrial fibrillation?

Introducción: la fibrilación auricular es la arritmia más frecuente en la práctica médica. Se asocia con una alta morbimortalidad, incluyendo accidentes cerebrovasculares, insuficiencia cardíaca y disminución de la calidad de vida. Los nuevos anticoagulantes orales tienen un riesgo hemorrágico no despreciable, lo que implica un problema en aquellos pacientes con alto riesgo de sangrado. Es así como el cierre percutáneo de orejuela izquierda surge como una alternativa en el tratamiento de pacientes con fibrilación auricular no valvular y alto riesgo de eventos tromboembólicos o complicaciones hemorrágicas. Objetivo: realizar un artículo de revisión acerca de la fibrilación auricular y el control del riesgo embólico, haciendo énfasis en la problemática actual de la anticoagulación oral y el uso de dispositivos de cierre percutáneo de la orejuela izquierda. Materiales y métodos: se realizó una búsqueda sistemática de artículos científicos en diferentes bases de datos, utilizando palabras claves y descriptores médicos que trataran acerca de la fibrilación auricular y los métodos terapéuticos utilizados en prevención de accidentes cerebrovasculares. Resultados: en total fueron analizados 59 artículos y sus hallazgos sugieren que el cierre percutáneo de orejuela izquierda es una posible alternativa en el tratamiento de pacientes con fibrilación auricular no valvular. Conclusiones: el cierre percutáneo de orejuela izquierda es eficaz en la prevención de accidente cerebrovascular en pacientes con fibrilación auricular no valvular con la potencial ventaja de no necesitar el uso crónico de anticoagulantes. MÉD.UIS. 2014;27(3):69-76.

Introduction: atrial fibrillation is the most common arrhythmia in clinical practice. Is associated with a high morbidity and mortality, including stroke, heart failure, and decreased of quality of life. The new oral anticoagulants have a non-negligible hemorrhagic risk, which implies a problem in those patients with high risk bleeding. Is as well percutaneous left atrial appendage closure emerges as an alternative in the treatment of patients with non-valvular atrial fibrillation and thromboembolic high risk or bleeding complications. Objective: to conduct a review article about atrial fibrillation and embolic risk control, with emphasis on the current problems of oral anticoagulation and the use of percutaneous left atrial appendage closure devices. Materials and methods: a systematic search of scientific articles was conducted in different databases, using key words and medical descriptors dealing about atrial fibrillation and the therapeutic methods used in stroke prevention. Results: in total 59 scientific articles were analyzed and theirs findings suggest that the percutaneous left atrial appendage closure is a possible alternative in the treatment of patients with non-valvular atrial fibrillation. Conclusions: the percutaneous left atrial appendage closure is effective in the prevention of stroke in patients with non-valvular atrial fibrillation with the potential advantage of not needing the chronic use of anticoagulants. MÉD.UIS. 2014;27(3):69-76.