Anafilaxia à lapa: um caso clínico raro / Limpet anaphylaxis: a rare case

A lapa (Patella vulgata) é um molusco frequentemente encontrado em regiões costeiras com clima quente. A alergia alimentar à lapa é muito rara, com poucos casos descritos na literatura. Os autores descrevem um caso de anafilaxia à lapa, com evidência de reação de hipersensibilidade do tipo I, através de IgE específica positiva à lapa, tanto com métodos in vivo, como in vitro.

Limpet (Patella vulgata) is a mollusk mainly found in warm coastal regions. Limpet allergy is considered rare, and few cases can be found in the literature. We describe a clinical case of limpet anaphylaxis, including in vitro and in vivo evidence of IgE mechanism involvement.

Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report / Consideraciones anestésicas y quirúrgicas en nefrectomía bilateral en dos tiempos en un paciente pediátrico: Reporte de caso

Abstract We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Resumen Se presenta un paciente de 9 años de edad con enfermedad renal terminal, en diálisis peritoneal, quien se sometió a nefrectomía bilateral retroperitoneoscópica estadificada en posición prona. Se indicó la nefrectomía bilateral en preparación para trasplante renal en el contexto de predisposición genética hacia desarrollar una patología maligna al estar inmunosuprimido. Las dos cirugías en espejo permiten hacer una comparación del manejo anestésico y de los desenlaces en un mismo paciente. Las características de interés para los anestesiólogos incluyen el abordaje de un niño con enfermedad renal crónica, con requisitos diferentes de antihipertensivos intraoperatorios; estrategias para el manejo del dolor, incluyendo una comparación de bloqueo del plano del erector espinal con y sin dexmedetomidina adyuvante; manejo anestésico de cirugía pediátrica retroperitoneoscópica y la primera descripción del uso de una bolsa Foley conectada a un catéter de diálisis peritoneal para ayudar en el diagnóstico y la reparación de la entrada de la cavidad peritoneal posterior.

Manejo laparoscópico de hernia diafragmática traumática: reporte de un caso / Laparoscopic management of traumatic diaphragmatic hernia: a case report

La hernia diafragmática traumática representa un reto al momento del diagnóstico. Una detección oportuna permite establecer un correcto tratamiento quirúrgico. Se presenta el caso de un paciente masculino de 37 años de edad con antecedente de trauma torácico por arma blanca 4 años antes; quien acude por cuadro de dolor abdominal intenso localizado en epigastrio que se irradia a hipocondrio izquierdo de aparición súbita 72 horas antes de su ingreso. Al examen físico murmullo vesicular disminuido en campo pulmonar izquierdo, y abdomen doloroso a la palpación a nivel de epigastrio e hipocondrio izquierdo. En exámenes de laboratorio no se evidencian alteraciones, mientras que la tomografía reporta hernia diafragmática izquierda; la misma que fue resuelta quirúrgicamente mediante técnica laparoscópica.

Traumatic diaphragmatic hernia represents a challenge at diagnosis. A timely detection allows to establish a correct surgical treatment. It is presented the case of a 37-year-old male patient with a history of stabbing chest trauma 4 years earlier; who comes for symptoms of intense abdominal pain located in the epigastrium that radiates to the left hypochondrium of sudden onset 72 hours before admission. On physical xamination, vesicular murmur decreased in the left lung field, and a painful abdomen on palpation at the level of the epigastrium and left hypochondrium were showed. Laboratory tests did not show any alterations, but tomography reports a left diaphragmatic hernia; this one was solved surgically by laparoscopic technique.

Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

BACKGROUND Left ventricular aneurysm (LVA) is indicator of high morbidity in Chagas' disease. A cross-sectional study performed identified LVA in 18.8% of the chronic chagasic patients (CCP). OBJECTIVE Determine the risk of death of patients with chronic chagasic cardiopathy (CCC) and LVA in 24-year interval. MATERIAL AND METHODS In 1995 a cohort of 298 CCP was evaluated by anamnesis, physical examination, EKG and ECHO and classified in groups: G0 = 86 without cardiopathy; G1 = 156 with cardiopathy without LVA and G2 = 56 with cardiopathy and LVA. 38 patients of G0 and G1 used benznidazole. Information about the deaths was obtained in the notary, death certificates, hospital records and family members. FINDINGS Were registered 113 deaths (37.9%): 107 (35.9%) attributed to cardiopathy and 6 (2.0%) to other causes (p < 0.05). Amongst these 107 deaths, 10 (11.6%) occurred in G0; 49 (31.4%) occurred in G1 and 48 (85.7%) occurred in G2 (p < 0.05). The risk of death was 2.7 and 7.4 times significantly higher in G2, than in G1 and G0, respectively. CONCLUSION Chronic chagasic patients with LVA and ejection fraction < 45% have a higher risk of death than those without.

Digestive tract reconstruction with tubular stapler after 4K laparoscopic total gastrectomy / 中华消化外科杂志

Digestive tract reconstruction after laparoscopic total gastrectomy is one of the difficult problems faced by surgeons. The classical reconstruction method is Roux-en-Y esophagojejunostomy, which is mainly completed by two instruments: linear stapler and tubular stapler. Due to the advantages of wide application range and safety of anastomosis, the tubular stapler is most commonly used in clinical practice. The traditional method of esophagojejunostomy with tubular stapler is end-to-side esophagojejunostomy. Because this method is directly transplanted from open surgery, there are many difficulties in the actual operation. Semi end to end esophagojejunostomy is an improved reconstruction method with tubular stapler. It is easy to operate and has less complications. It is the optimal choice for digestive tract reconstruction after laparoscopic total gastrectomy. With the help of 4K laparoscopic system, the operation is more accurate. The authors summarize key points of digestive tract reconstruction with tubular stapler after 4K laparoscopic total gastrectomy.

Modified strategy of anesthesia for laparoscopic radical resection of rectal carcinoma: ultrasound-guided anterior quadratus lumborum block combined with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups ( n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group ( group QG) and general anesthesia group ( group G) . In group QG, anteri-or quadratus lumborum block was performed with 0. 33％ ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side. Combined intravenous-inhalational anesthesia was applied, propofol 3-5μg∕ml and remifentanil 3-5 ng∕ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups. Patient-controlled intravenous analgesia with sufentanil 2μg∕kg was used for postoperative analgesia. The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval. Bruggrmann comfort scale ( BCS) scores were recorded at 1, 6, 12, 24 and 48 h after operation ( T1-5 ) . Tramadol was used for rescue analgesic after operation. The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients' satisfaction with postoperative analgesia were recorded. The emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were also recorded. The develop-ment of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4,5 , the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients' satisfaction with postoperative an-algesia was increased, and the emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were shortened in group QG (P<0. 05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma.

Pedicle omentum flap harvested by laparoscopy in breast oncoplastic sugery / 中国癌症杂志

Surgery is one of the most important treatments for breast cancer. A part of the early breast cancer patients demand further oncoplastic breast surgery to reconstruct or restore the breast cosmosis after conventional breast conserving surgery, by oncoplastic breast surgery, which is a modern conception and technique including volume dis-placement and volume replacement. Oncoplastic breast surgery using pedicled omental flap is a new approach among volume replacement techniques. It has made some progress in recently years. A systematic review was therefore con-ducted to analyze and illuminate the present status.

Beach almond (Terminalia catappa, Combretaceae) seed production and predation by scarlet macaws (Ara macao) and variegated squirrels (Sciurus variegatoides) / Producción de semillas y depredación del almendro de playa (Terminalia catappa, Combretaceae) por lapas rojas (Ara macao) y ardillas chizas (Sciurus variegatoides)

Knowledge of ecological impacts of exotic beach almond (Terminalia catappa) in the central Pacific of Costa Rica are little known, but studies have found this species to be a potentially important food source for endangered scarlet macaws (Ara macao). In this study, reproductive phenology and seed predation by variegated squirrels (Sciurus variegatoides) and scarlet macaws were measured during March and April 2011 on beaches of central Pacific coastal Costa Rica. Seed productivity and predation levels were quantified on a weekly basis for 111 beach almond trees to assess the importance of beach almond as a food source for scarlet macaws and the extent of resource partitioning between seed predators. Seed production of the trees was great (about 194 272 seeds) and approximately 67% of seeds were predated by seed predators. Macaws consumed an estimated 49% of seeds while squirrels consumed 18%. Additionally, evidence of resource partitioning between squirrels and macaws was found. Scarlet macaws preferred to feed on the northern side and edge of the canopy while squirrels preferred to feed on the southern and inside parts of the canopy. Both species ate most seeds on the ocean side of the tree. Despite the status of this tree as an exotic species, the beach almond appears to be an important resource for scarlet macaw population recovery. The resource produced by this tree should be taken into account as reforestation efforts continue in Costa Rica. Rev. Biol. Trop. 62 (3): 929-938. Epub 2014 September 01.

El conocimiento de los impactos ecológicos del almendro de playa exótico (Terminalia catappa) en el Pacífico Central de Costa Rica son poco conocidos, pero los estudios han encontrado que esta especie es una fuente de alimento potencialmente importante para la lapa roja (Ara macao), en peligro de extinción. En este estudio, se midieron la fenología reproductiva y la depredación de semillas por las ardillas (Sciurus variegatoides) y lapas rojas durante marzo y abril 2011 en las playas de la costa Pacífica Central de Costa Rica. Los niveles de productividad y depredación de semillas se cuantificaron semanalmente para 111 almendros de playa, para evaluar la importancia del almendro de playa como fuente de alimento para la lapa roja y el grado de repartición de recursos entre los depredadores de semillas. La producción de semillas de los árboles fue alta (cerca de 194 272 semillas) y aproximadamente el 67% de las semillas fueron comidas por los depredadores, las lapas rojas consumen un estimado de 49% de las semillas, mientras que las ardillas consumen el 18%. Adicionalmente, se encontró evidencia de la repartición de recursos entre las ardillas y las lapas. Las lapas rojas prefieren alimentarse en el lado norte y el borde de la copa, mientras que las ardillas prefieren las regiones del sur y el interior de la copa. Ambas especies se comieron la mayoría de las semillas en la parte del árbol con lado al mar. A pesar de la situación de este árbol como una especie exótica, la playa de almendras parece ser un recurso importante para la recuperación de la población de lapas rojas. El recurso que produce este árbol debe tomarse en cuenta para continuar con los esfuerzos de reforestación en Costa Rica.

Biología de la lapa (Cuniculus paca Brisson): una perspectiva para la zoocría / Biology of agouti (Cuniculus paca Brisson): a breeding perspective / Biologia da Paca (Cuniculus paca Brisson): uma perspectiva para sua criação em cativeiro

La lapa (Cuniculus paca) es un roedor de la región neotropical. Es de mediano tamaño, noctámbulo, solitario, territorial y sedentario. Es utilizada como fuente de alimento por la población indígena y rural. Su demanda es creciente, dado el exquisito sabor de su carne, incrementándose su caza para comercio ilegal. Lo anterior ha generado la extracción indiscriminada de su hábitat natural, causando una seria reducción de sus poblaciones. La zoocría es una alternativa para mitigar su depoblación. En Brasil, Ecuador, Panamá, México y Colombia se ha intentado su reproducción en cautiverio, con resultados interesantes. El objetivo del presente artículo de revisión es dar a conocer los comportamientos biológicos de lapa in situ y ex situ, para su manejo adecuado en cautiverio.

The agouti (Cuniculus paca) is a rodent of the Neotropics. It is medium-sized, night owl, solitary, territorial, and sedentary. Indigenous and rural populations use it is a food source. Illegal hunting and trade of agouti is increasing given the exquisite flavor of its meat. This has led to an indiscriminate extraction from their natural habitat, causing a serious reduction in its wild populations. Farm breeding is an alternative to mitigate its depopulation. Researchers in Brazil, Ecuador, Panama, Mexico, and Colombia have attempted to breed agouti in captivity, with interesting results. The aim of this review is to present the in situ and ex situ behavior of agouti for its proper handling in captivity.

A Paca (Cuniculus paca) é um roedor da região neotropical de tamanho médio, hábitos noturnos, solitário, territorial e sedentário. É utilizada como fonte de alimento pela população indígena e rural. Atualmente tem aumentado a demanda de carne de Paca por ser muito gostosa e palatável, o qual incrementou a caça predatória e o comercio ilegal, gerando uma seria diminuição progressiva de suas populações em seus habitats naturais. Uma alternativa para mitigar este problema é a criação zootécnica em cativeiro. Tem se realizado alguns ensaios para lograr sua reprodução com resultados interessantes no Brasil, Equador, Panamá, México e na Colômbia, mas seu objetivo tem sido principalmente a pesquisa ou a conservação. Embora, existem experiências em estes países que tem permitido conhecer parâmetros zootecnicos idôneos para sua criação comercial em cativeiro. O objetivo do presente artigo de revisão é dar a conhecer os comportamentos biológicos da Paca in situ e ex situ para seu manejo adequado e pertinente em cativeiro para fins comerciais.

Scarlet Macaw (Ara macao) (Psitaciformes: Psittacidae) Parental Nest Visitation in Costa Rica: Implications for Research and Conservation

We studied temporal parental visitation of Scarlet Macaws (Ara macao) to six active nests in the Central Pacific Conservation Region of Costa Rica. Total parental time in the nest decreased significantly as the nestlings aged. Results provide guidelines to scientists for planning invasive activities to nestlings, such as placement of radio collars, or biological sample collection. These activities should be performed close to the end of the nesting period for minimal disturbance of parents and nestlings. Our results also provide information to aid wildlife guards in protecting active nests from poachers when chicks are close to fledging. Rev. Biol. Trop. 57 (1-2): 395-400. Epub 2009 June 30.

Estudiamos las visitas temporales de padres de la lapa roja (Ara macao) a seis nidos activos en el Área de Conservación del Pacifico Central (Costa Rica). El tiempo total que pasaron los padres en los nidos bajó en forma significativa en relación con el crecimiento de los pichones. Estos resultados pueden ayudar a los científicos a planear sus actividades "invasivas", tales como colocación de radio collares o colección de muestras biológicas. Las actividades deben coincidir con el final de la época de anidación para molestar menos a las aves. Nuestros resultados proveen información que puede ayudar a los guardaparques a proteger nidos activos cuando los pichones estan casi listos para salir.

Scarlet Macaw, Ara macao, (Psittaciformes: Psittacidae) diet in Central Pacific Costa Rica

From 1993 to 1997, we observed Scarlet Macaw (Ara macao) feeding behavior in Central Pacific Costa Rica. Feeding data acquired in this study were not collected systematically, but opportunistically whenever macaws were observed feeding. To supplement feeding observations, we conducted interviews with local residents. Scarlet Macaws fed on seeds, fruits, leaves, flowers and/or bark of 43 plant species. Various plant parts eaten by macaws from several tree species contain secondary compounds toxic to humans, and additional species included in their diet are nonnative, introduced for agricultural purposes. Important macaw feeding tree species are Ceiba pentandra, Schizolobium parahybum, and Hura crepitans; these species are also crucial to this macaw population because of nest cavities they provide. The results of this study contribute to the conservation of Scarlet Macaws in Central Pacific Costa Rica through promoting protection of individual trees, and through local elementary school reforestation programs focusing on tree species that macaws use for feeding and/or nesting. Scarlet Macaw conservation is extremely important, as numerous population pressures have caused significant declines in macaw numbers in Costa Rica.

Entre 1993-97, observamos el comportamiento de alimentación de la lapa roja (Ara macao) en el Pacifico Central de Costa Rica. La lapa roja se alimentó de semillas, frutas, hojas, flores y corteza de 43 especies de plantas. Varias partes de las plantas comidas por las lapas contienen compuestos secundarios tóxicos al ser humano, y especies adicionales incluidas en la dieta son exóticas; introducidas por razones agrícolas, forestales o estéticas. Especies de árboles importantes como alimento de la lapa roja incluyen: Ceiba pentandra, Schizolobium parahybum, y Hura crepitans; también son criticas para la población de la lapa roja debido a proveen cavidades para anidación. Los resultados de este estudio contribuyen a la conservación de la lapa roja en el Pacifico Central de Costa Rica a través de la promoción de la protección de árboles individuales y programas de reforestación a nivel de escuela primaria que se enfocan en especies de árboles que la lapa utiliza para alimentación o anidación. La conservación de la lapa roja es importante, debido al declive de sus números en Costa Rica.