Diretivas antecipadas de vontade na perspectiva da população idosa de um município do meio oeste catarinense / Advance directives in the perspective of the older adults of a municipality in the Midwest of Santa Catarina

Resumo Objetivo Analisar o conhecimento da pessoa idosa em um município do meio oeste catarinense acerca da elaboração das Diretivas Antecipadas de Vontade (DAV), a sua preferência em relação aos modelos de preenchimento e a escolha do representante que irá substitui-la na tomada de decisão. Método Estudo transversal realizado por meio da disponibilização aos participantes de dois modelos de DAV para preenchimento e aplicação de um questionário sobre conhecimento, aceitação e avaliação do dispositivo. Resultados A maioria dos participantes (85,63%) desconhecia as DAV; 98,13% desconheciam os modelos do documento; 100% consideraram bom ou aceitável o modelo 1, mais completo; 66,88% indicaram um filho como representante legal. Questionados sobre a importância da elaboração, disponibilização à população e aprovação de lei que regulamente esse direito, as respostas foram afirmativas, respectivamente, para 91,88%, 91,25% e 91,25% dos participantes. Apenas 5% dos respondentes apontaram dificuldades no entendimento dos modelos, sendo a "linguagem" o item de maior dificuldade. Conclusão A maioria das pessoas idosas desconhecia os modelos de DAV, mas referiram o modelo 1, considerando-o bom ou aceitável. A maioria não teve dificuldades no entendimento e reconheceu a importância da elaboração e disponibilização das DAV à população, assim como a necessidade de uma lei para regulamentar esse direito. Observou-se uma alta proporção de participantes indicando um filho como representante legal, enfatizando a importância de envolver a família nesse processo. Esses resultados ressaltam a necessidade de conscientizar as pessoas idosas sobre as DAV e disponibilizar modelos claros e abrangentes.

Abstract Objective To analyze the knowledge of older individuals in a municipality in the Midwestern region of Santa Catarina regarding the development of Advance Directives, their preferences regarding the available models, and the selection of a representative to make decisions on their behalf. Method Cross-sectional study carried out by providing participants with two models of Advance Directives were made available to the participants for completion and applied a questionnaire on knowledge, acceptance, and evaluation of the device. Results There were 85.63% of the participants who were unaware of the Advance Directives, 98.13% who were unaware of document models, 100% who considered model 1, more complete, to be good or acceptable, and 66.88% who indicated an adult child as its representative. When asked about the importance of preparing, making available to the population, and passing a law that regulates this right, the participants were assertive respectively by 91.88%, 91.25% and 91.25%. Conclusion Most older people were unaware of the AD models, but mentioned model 1, considering it good or acceptable. Most had no difficulties in understanding and recognized the importance of preparing and making AD available to the population, as well as the need for a law to regulate this right. There was a high proportion of participants indicating an adult child as a legal representative, emphasizing the importance of involving the family in this process. These results highlight the need to make older people aware of AD and provide clear and comprehensive models.

Contaminação parasitária em hortaliças comercializadas no município de Jataí-GO / Parasitic contamination in vegetables commercialized in the city of Jataí-GO

Introdução: a prevalência de doenças parasitárias transmitidas por alimentos tem apresentado um aumento significativo em nível mundial, destacando principalmente as hortaliças, consumidas in natura, em razão da sociedade moderna que procura hábitos de vida mais saudáveis. Objetivo:avaliar a contaminação de hortaliças comercializadas no município de Jataí, GO, por enteroparasitos. Metodologia: foi realizada uma pesquisa experimental para detecção de estruturas parasitárias em hortaliças de cultivo tradicional e hidropônico, obtidas de nove estabelecimentos: três supermercados, três hortas e três feiras livres. Foram obtidas 54 amostras de alface (Lactuca sativa), 54 de rúcula (Chicarium sp.) e 18 de agrião (Nasturtiumofficinale). As amostras foram lavadas com água destilada e solução Tween 80 e submetidas as técnicas de sedimentação espontânea e por centrifugação. Foi realizado um mapeamento da área de estudo para identificação da localização dos estabelecimentos. Resultados: a positividade para estruturas parasitárias foi de 94,4% (119/126). A alface apresentou maior prevalência de parasitos 96,2% (52/54). Foi observada diferença estatística significativa ao comparar o emprego das duas técnicas (p < 0,05). Ashortaliças submetidas a técnica de sedimentação espontânea apresentaram maior positividade 115/126 (91,3%). Não foi observada diferença estatística significante quanto ao tipo de cultivo, porém, houve forte associação em relação ao local de cultivo e contaminação das hortaliças (OR: 3,625). Verificou-se maior percentual de positividade nos estabelecimentos localizados próximos aos rios. Conclusão: a positividade de enteroparasitos detectada nas hortaliças foi alta, ressaltando a necessidade de implementar medidas que visam a conscientização da população, em relação às práticas de higienização das hortaliças antes do consumo.

Introduction: the prevalence of parasitic diseases transmitted by food has shown a significant increase worldwide, especially vegetables, consumed in natura, due to modern society that seeks healthier lifestyles. Objective: to evaluate the contamination of vegetables commercialized in the city of Jataí, GO, by enteroparasites. Methodology: an experimental research was carried out to detect parasitic structures in vegetables of traditional and hydroponic cultivation, obtained from nine establishments: three supermarkets, three vegetable gardens and three street markets. Fifty four samples of lettuce (Lactuca sativa), 54 of arugula (Chicarium sp.) and 18 of watercress (Nasturtium officinale) were obtained. The samples were washed with distilled water and Tween 80 solution and submitted to spontaneous sedimentation and centrifugation techniques. A mapping of the study area was carried out to identify the location of the establishments. Results: positivity for parasitic structures was 94.4% (119/126). Lettuce had a higher prevalence of parasites 96.2% (52/54). A statistically significant difference was observed when comparing the use of the two techniques (p < 0.05). Vegetables submitted to the spontaneous sedimentation technique showed higher positivity 115/126 (91.3%). There was no statistically significant difference regarding the type of cultivation, however, there was a strong association in relation to the place of cultivation and contamination of vegetables (OR: 3.625). There was a higher percentage of positivity in establishments located near the rivers. Conclusion: the positivity of intestinal parasites detected in vegetables was high, highlighting the need to implement measures aimed at raising awareness of the population regarding the practices of cleaning vegetables before consumption.

Topografia dos órgãos abdominais em Didelphis albiventris / Topography of abdominal organs in Didelphis albiventris

O conhecimento da localização dos órgãos nas diferentes regiões do corpo do animal é essencial para a prática clínica, cirúrgica e para o diagnóstico por imagem. O objetivo do estudo foi descrever a anatomia topográfica abdominal do Didelphisalbiventris. Foram utilizados quatro cadáveres (animais jovens), dois destes destinados para o estudo macroscópico em peças a fresco e os outros fixados em solução aquosa de formaldeído a 10%. Os cadáveres foram dissecados e as estruturas anatômicas identificadas, analisadas e fotografadas. A maioria dos órgãos localizados na região abdominal dos cadáveres da espécie D. albiventris apresentou posição similar aos dos caninos, porém, alguns órgãos e a localização de determinadas estruturas apresentaram particularidades importantes, como a presença dos ossos epipúbicos, a ausência do lobo hepático quadrado, a presença de um ceco desenvolvido e o cólon dividido em três segmentos.

The knowledge about localization of organs in different regions of the animal’s body is essential for clinical, surgical and diagnostic imaging practice. The purpose of this study was to describe the abdominal topographic anatomy of Didelphis albiventris. Was used four dead bodys (young animals), two of these was intended for the macroscopic study of fresh pieces and the others fixed in 10% aqueous formaldehyde solution. The corpses was dissected and the anatomic structures was identified, analyzed and photographed. Most of the organs located in the abdominal region of cadavers from species D. albiventris presented structure and position similar to canines, however some of these organs and localization of structures presented important particularities, like the presence of epipubic bones, absence of square hepatic lobe, presence of an developed cecum and colon divided into three segments.

Topografia dos órgãos abdominais em Didelphis albiventris / Topography of abdominal organs in Didelphis albiventris

O conhecimento da localização dos órgãos nas diferentes regiões do corpo do animal é essencial para a prática clínica, cirúrgica e para o diagnóstico por imagem. O objetivo do estudo foi descrever a anatomia topográfica abdominal do Didelphisalbiventris. Foram utilizados quatro cadáveres (animais jovens), dois destes destinados para o estudo macroscópico em peças a fresco e os outros fixados em solução aquosa de formaldeído a 10%. Os cadáveres foram dissecados e as estruturas anatômicas identificadas, analisadas e fotografadas. A maioria dos órgãos localizados na região abdominal dos cadáveres da espécie D. albiventris apresentou posição similar aos dos caninos, porém, alguns órgãos e a localização de determinadas estruturas apresentaram particularidades importantes, como a presença dos ossos epipúbicos, a ausência do lobo hepático quadrado, a presença de um ceco desenvolvido e o cólon dividido em três segmentos.

The knowledge about localization of organs in different regions of the animal's body is essential for clinical, surgical and diagnostic imaging practice. The purpose of this study was to describe the abdominal topographic anatomy of Didelphis albiventris. Was used four dead bodys (young animals), two of these was intended for the macroscopic study of fresh pieces and the others fixed in 10% aqueous formaldehyde solution. The corpses was dissected and the anatomic structures was identified, analyzed and photographed. Most of the organs located in the abdominal region of cadavers from species D. albiventris presented structure and position similar to canines, however some of these organs and localization of structures presented important particularities, like the presence of epipubic bones, absence of square hepatic lobe, presence of an developed cecum and colon divided into three segments.

Educational interventions for physical activity among Brazilian adults: systematic review / Intervenções educativas para atividade física em adultos brasileiros: revisão sistemática

ABSTRACT OBJECTIVE To summarize the main evidence from educational interventions designed to increase levels of physical activity (PA) among Brazilian adults. METHODS Systematic review of intervention studies carried out in Brazil that implemented educational components aimed at promoting increased levels of PA among adult populations (18 to 65 years old). In October 2020, systematic searches were conducted in six databases, and in the reference lists of the assessed studies. RESULTS Of the initial 2,511 studies, nine were included in the synthesis. Samples with specific characteristics (such as social vulnerability, physical inactivity, and overweight or obesity) were observed, with a greater number of women. Five interventions (55.6%) occurred in primary healthcare settings (PHC) of the Brazilian Unified Health System (SUS). Only four studies (44.4%) described the pedagogical frameworks structuring the educational approaches, among which counseling was the most used strategy, such as those carried out through face-to-face meetings, home visits, lectures, and phone calls (n = 8; 88.9%). Positive results were observed in three different indicators: increase in weekly PA volume (n = 4); increase in leisure-time PA rate (n = 1); and increase in the proportion of women classified as "very active/active" (n = 1). Given the sampling specificities, the domain "participant selection" showed a high number of interventions with high risk of bias. CONCLUSIONS Educational approaches engendered some positive effects on different PA indicators, notably counseling as the main strategy used and approaches involving other health themes, such as nutrition and stress. However, considering the several determinants of PA in Brazil, future interventions should be conducted in different locations of Brazil in order to evaluate, in a broader way, their implementation processes and articulation with the many professionals working in PHC.

RESUMO OBJETIVO Sumarizar as principais evidências de intervenções educativas delineadas para o aumento dos níveis de atividade física (AF) em adultos brasileiros. MÉTODOS Revisão sistemática de estudos de intervenção conduzidos no Brasil, que implementaram componentes educativos com a finalidade de promover o aumento dos níveis de AF em populações de adultos (18 a 65 anos). Em outubro de 2020, buscas sistemáticas foram conduzidas em seis bases de dados e nas listas de referências dos artigos avaliados. RESULTADOS Dos 2.511 artigos iniciais, nove compuseram a síntese. Foram observadas amostras com características específicas (como vulnerabilidade social, inatividade física e sobrepeso ou obesidade), com maior número de mulheres. Cinco intervenções (55,6%) ocorreram nos cenários da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS). Apenas em quatro estudos (44,4%) houve descrição dos referenciais pedagógicos estruturantes das abordagens educativas, dentro os quais o aconselhamento se configurou como a estratégia mais utilizada, como aquelas realizadas por meio de encontros presenciais, visitas domiciliares, palestras e chamadas telefônicas (n = 8; 88,9%). Resultados positivos foram observados em três distintos indicadores: aumento do volume semanal de AF (n = 4); aumento do índice de AF no lazer (n = 1); e aumento da proporção de mulheres classificadas como "muito ativas/ativas" (n = 1). Visto as especificidades amostrais, o domínio "seleção dos participantes" apresentou elevado número de intervenções com alto risco de viés. CONCLUSÕES As abordagens educativas produziram alguns efeitos positivos em distintos indicadores de AF, destacando-se o aconselhamento como principal estratégia utilizada e as abordagens que envolveram outras temáticas de saúde, como nutrição e estresse. Contudo, frente aos diversos determinantes da AF no Brasil, é importante que futuras intervenções sejam conduzidas em variadas localizações do país, de forma que avaliem, de maneira mais ampla, seus processos de implementação e articulação com os distintos profissionais que atuam na APS.

Características de carcaça, órgão vomeronasal, concentrações séricas de testosterona e IGF-I em machos Nelore com ductos incisivos bloqueados / Characteristics of carcass, vomeronasal organ, serum testosterone andIGF-I concentrations in Nellore males with blocked incisor ducts

Objetivou-se avaliar características quali - quantitativas da carcaça em machos Nelore, submetidos ao bloqueio dos ductos incisivos no período pré puberal. Além disso, objetivou-se avaliar as concentrações séricas de testosterona e do hormônio do crescimento semelhante a insulina do tipo I (IGF-I), e a arquitetura histológica do órgão vomeronasal (OVN). Trinta e quatro machos, no período pré puberal, foram divididos em três grupos experimentais: inteiros – animais controle sem qualquer procedimento (n = 11); bloqueados - animais com os ductos incisivos bilateralmente obstruídos (n = 10); castrados - animais com orquiepididectomia bilateral (n = 13). O OVN foi obtido no abate, ao final do experimento, para avaliação histomorfométrica. As coletas de sangue foram realizadas a cada três meses, em dois turnos (manhã e tarde), totalizando cinco avaliações. Observaram-se maiores (P0,05). Registrou-se redução da altura do epitélio neuro sensitivo do OVN nos bloqueados e castrados (P<0,05). Foi registrada menor concentração de testosterona nos bloqueados nas coletas quatro e cinco à tarde (P<0,05). Conclui-se que a obstrução dos ductos incisivos reduziu os estímulos sensoriais para o OVN, que por sua vez, promoveu alteração na concentração sérica de testosterona, sem alterar o ganho de peso dos animais, porém, não promoveu melhoria na qualidade da carcaça nas condições deste estudo.

A total of 34 prepuberal Nellore males were divided into three groups: control – animals without any procedure (n = 11); blocked - with bilaterally incisors ducts obstructed (n = 10); castrated - with bilateral orchiectomy (n = 13). This study aimed to evaluate the effect of blocking the vomeronasal organ (VNO) in qualitative and quantitative characteristics of the carcass. Also, this study aimed to evaluate testosterone and insulin-like growth factor (IGF-I) serum concentration, and the histological architecture of the OVN. Blood samples were taken every three months during two daily collections (morning and afternoon), totalizing five evaluations. It was observed higher (P 0.05). It was observed a reduction (P<0.05) of the VNO sensory epithelium height in blocked and castrated groups compared with control group. It was registered lower (P<0.05) serum testosterone concentration in blocked group at the fourth and fifth blood collection (afternoon). It was concluded that the obstruction of the incisive ducts reduced the sensorial stimuli for the OVN, which, in turn, promoted a change in the serum concentration of testosterone, without altering the weight gain of the animals, but did not promote improvement in the quality of the carcass under the conditions of this study.

Características de carcaça, órgão vomeronasal, concentrações séricas de testosterona e IGF-I em machos Nelore com ductos incisivos bloqueados / Characteristics of carcass, vomeronasal organ, serum testosterone and IGF-I concentrations in Nellore males with blocked incisor ducts

Objetivou-se avaliar características quali - quantitativas da carcaça em machos Nelore, submetidos ao bloqueio dos ductos incisivos no período pré puberal. Além disso, objetivou-se avaliar as concentrações séricas de testosterona e do hormônio do crescimento semelhante a insulina do tipo I (IGF-I), e a arquitetura histológica do órgão vomeronasal (OVN). Trinta e quatro machos, no período pré puberal, foram divididos em três grupos experimentais: inteiros ­ animais controle sem qualquer procedimento (n = 11); bloqueados - animais com os ductos incisivos bilateralmente obstruídos (n = 10); castrados - animais com orquiepididectomia bilateral (n = 13). O OVN foi obtido no abate, ao final do experimento, para avaliação histomorfométrica. As coletas de sangue foram realizadas a cada três meses, em dois turnos (manhã e tarde), totalizando cinco avaliações. Observaram-se maiores (P<0,05) pesos corporais finais (inteiros = 494,1 ± 28,71; bloqueados = 500,6 ± 23,6 e castrados = 468,3 ± 21,8 Kg) nos inteiros e bloqueados. O acabamento da carcaça foi maior nos castrados (P<0,05) em relação aos inteiros e bloqueados, enquanto o rendimento de carcaça não apresentou diferenças entre os três tratamentos (P>0,05). Registrou-se redução da altura do epitélio neuro sensitivo do OVN nos bloqueados e castrados (P<0,05). Foi registrada menor concentração de testosterona nos bloqueados nas coletas quatro e cinco à tarde (P<0,05). Conclui-se que a obstrução dos ductos incisivos reduziu os estímulos sensoriais para o OVN, que por sua vez, promoveu alteração na concentração sérica de testosterona, sem alterar o ganho de peso dos animais, porém, não promoveu melhoria na qualidade da carcaça nas condições deste estudo.

A total of 34 prepuberal Nellore males were divided into three groups: control ­ animals without any procedure (n = 11); blocked - with bilaterally incisors ducts obstructed (n = 10); castrated - with bilateral orchiectomy (n = 13). This study aimed to evaluate the effect of blocking the vomeronasal organ (VNO) in qualitative and quantitative characteristics of the carcass. Also, this study aimed to evaluate testosterone and insulin-like growth factor (IGF-I) serum concentration, and the histological architecture of the OVN. Blood samples were taken every three months during two daily collections (morning and afternoon), totalizing five evaluations. It was observed higher (P<0.05) final body weight (control= 494.1 ± 28.71; blocked = 500.6 ± 23.6; castrated = 468.3 ± 21.8 kg) at the control and blocked groups. Carcass finishing was higher in castrated animals (P <0.05), while carcass yield did not differ between treatments (P> 0.05). It was observed a reduction (P<0.05) of the VNO sensory epithelium height in blocked and castrated groups compared with control group. It was registered lower (P<0.05) serum testosterone concentration in blocked group at the fourth and fifth blood collection (afternoon). It was concluded that the obstruction of the incisive ducts reduced the sensorial stimuli for the OVN, which, in turn, promoted a change in the serum concentration of testosterone, without altering the weight gain of the animals, but did not promote improvement in the quality of the carcass under the conditions of this study.

Crude glycerin in meat goat diets: intake, performance and carcass traits / Glicerina bruta na dieta de caprinos de corte: consumo, desempenho e características de carcaça

ABSTRACT: This experiment aimed to evaluate the effect of including glycerin in kid goats diet on intake, performance and carcass traits. Twenty intact male kid goats Boer crossbred were used, with body weight of 25.06±4.15kg and 8.00±0.66 months old, allocated in block design, with four treatments and five replicates. The treatments consisted on including dry matter basis (DM) of the diet of four levels of glycerin: zero, five, 10 and 15%, in replacing corn. It was not reported influence (P>0.05) of level of glycerin on intake of forage and feed conversion of animals. The concentrate and total DM intake were affected (P<0.05) for the level of glycerin in DM, with reduction in the animals that received the highest level. It was not reported influence (P>0.05) of level of glycerin on weight gain, carcass yield and percentage of cooling losses. However, the hot and cold carcass weight was lower (P<0.05) to the animals feed with 15% of glycerin. The inclusion up to 15% of glycerin in the diet of kid goats Boer crossbred, although did not affect feed conversion and performance, compromised the intake and carcass weight.

RESUMO: Objetivou-se avaliar o efeito da inclusão de glicerina na dieta de cabritos sobre o consumo, desempenho e características de carcaça. Foram utilizados 20 cabritos não castrados, mestiços Boer, com peso corporal médio de 25,06±4,15 kg e 8,00±0,66 meses de idade, distribuídos em blocos ao acaso, com quatro tratamentos e cinco repetições. Os tratamentos consistiram da inclusão de glicerina (87% de glicerol) na dieta, em substituição ao milho, em quatro níveis de concentração: zero, cinco, 10 e 15% na matéria seca (MS). Não foi encontrada influência (P>0,05) da glicerina na dieta sobre o consumo de volumoso e a conversão alimentar. Os consumos de concentrado e de MS total foram afetados (P<0,05) pelo nível de glicerina na MS, com redução nos animais que receberam o mais alto nível. Não houve efeito (P>0,05) dos níveis de glicerina para ganho de peso, rendimento de carcaça e perdas por resfriamento. Entretanto, houve efeito (P<0,05) para peso da carcaça quente e fria para os animais alimentados com 15% de glicerina. A inclusão de até 15% de glicerina na dieta de cabritos mestiços Boer, embora não afete a conversão alimentar e o desempenho, compromete o consumo e o peso da carcaça dos animais.

Are we following the guidelines on non-muscle invasive bladder cancer?

ABSTRACT Objectives To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA). Materials and Methods Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered. Results There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month. Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR. High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%). Conclusion SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement.

Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

ABSTRACT Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.

Laparoendoscopic single-site nephroureterectomy for morbid obese patients

Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled “en bloc” with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall.

Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN. .

Descrição do potencial de retenção de nitrogênio em frangas de postura por diferentes metodologias: máxima deposição e estimativas da ingestão de metionina+cistina / Description of the potential for nitrogen retention in pullets by different methodologies: maximum deposition and estimates of intake of methionine+cystine

Objetivou-se descrever o máximo potencial de deposição de nitrogênio e estimar a ingestão de metionina+cistina pela técnica do balanço de nitrogênio e abate comparativo. Foram realizados ensaios no período de 14 a 28, 56 a 70 e 98 a 112 dias de idade, utilizando 168 frangas Dekalb White, distribuídas em sete tratamentos e oito repetições. Os tratamentos consistiram de níveis de proteína na dieta, variando de 75 a 435 g kg-1 de matéria seca, em que a metionina+cistina foi o primeiro aminoácido limitante. As variáveis coletadas pelo abate comparativo foram nitrogênio ingerido e depositado e, nos ensaios de balanço de nitrogênio, coletaram-se ingestão e excreção de nitrogênio. Por meio da relação exponencial entre ingestão e deposição de nitrogênio, determinou-se a máxima deposição de nitrogênio. As técnicas foram comparadas pelo teste da razão de máxima verossimilhança. As técnicas descrevem de forma diferente o máximo potencial de deposição pela ave, mas são similares na estimativa da exigência de metionina+cistina. Com base em 60% do máximo potencial, as ingestões de metionina+cistina digestível foram estimadas em 163, 243 e 343 mg dia-1 para os período de 14 a 28, 56 a 70 e 98 a 112 dias de idade, respectivamente.

This study aimed to describe the maximum potential of nitrogen deposition and to estimate the intake of methionine+cystine by nitrogen balance and comparative slaughter. Assays were performed in the periodsof 14 to 28, 56 to 70 and 98 to 112 days of age, using 168 Dekalb White pullets, distributed in seven treatments and eight replications. Treatments consisted of protein levels in the diets ranging from 75 to 435 g kg-1 dry matter in which methionine+cystine was the first limiting amino acid. The variables collected by comparative slaughter were nitrogen intake and deposition and, in nitrogen balance trials were collected nitrogen intake and excretion. With the exponential relationship between nitrogen intake and deposition was determined the maximum nitrogen deposition. The techniques were compared by the test of maximum likelihood ratio. The techniques described differently the maximum potential for deposition by the bird, but were similar in the estimation of methionine+cystine. Based on 60% of the maximum potential the intakes of digestible methionine+cystine were estimated at 163, 243 and 343mg day-1 for the period of 14 to 28, 56 to70 and 98 to 112 days of age, respectively.

Retalho de rotação com cicatriz resultante em tridente para fechamento de meningomielocele / Closure of myelomeningocele defects using a rotation flap that resulted in a trident scar

Myelomeningocele is a defect of the spinal cord, spinal column, and skin covering these areas that results in the defective closure of the posterior portion of the neural tube during the fourth week of gestation. Its etiology is multifactorial and has yet to be clarified. The objective of this study was to demonstrate an addítional skin fiap alternative for the treatment of this defect. Closure with a flap that creates a trident-shaped scar has been shown to bea viable alternative that is easy to implement, reduces surgical time, minimizes blood loss, and requires no cutaneous grafts to cover the flap donor area.

A meningomielocele é um defeito da medula espinhal, da coluna vertebral e da pele sobre essa área, resultando em defeito no fechamento da porção posterior do tubo neural durantea quarta semana de gestação. Sua etiologia é multifatorial e ainda não está esclarecida. O objetivo deste trabalho é demonstrar mais uma opção de retalho de pele para tratamento desse defeito. O fechamento com retalho resultando em cicatriz em formato de tridente apresentou-se como alternativa viável, de fácil execução, com tempo cirúrgico reduzido e mínima perda sanguínea, não requerendo enxertos cutâneos para cobertura da área doadorados retalhos.

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

Purpose The purpose of this study is to determine if body mass index (BMI) and stone skin distance (SSD) affect stone free rate (SFR) in obese and morbid obese patients who underwent flexible URS for proximal ureteral or renal stones < 20 mm. Materials and Methods A retrospective chart review was performed of consecutive patients that underwent flexible URS. Inclusion criteria were: proximal ureteral stones and renal stones less than 20 mm in the preoperative computed tomography (CT). SFR were then compared according to SSD and BMI. Results A total of 153 patients were eligible for this analysis, 49 (32.02%) with SSD < 10 cm and 104 (67.97%) with SSD ≥ 10 cm. The mean stone size was 10.5 ± 6.4 mm. The overall SFR in our study was 82.4%. The SFR for the SSD < 10 and ≥ 10 were 79.6% and 83.7% respectively (p = 0.698) and for BMI < 30, ≥ 30 and < 40 and ≥ 40 were 82.9%, 81.7% and 90.9% respectively. Regression analysis showed no affect between BMI or SSD regarding SFR. Conclusion Ureteroscopy should be considered as a first-line of treatment for renal/proximal stones in obese and morbid obese patients. URS may be preferable to SWL in obese patients independently of the SSD, BMI or the location of proximal stones. .

Comparative dermatology: blue nevus / Dermatologia comparativa: nevo azul

There are elements in nature that may be compared to some dermatological lesions, such as the black pearl, which is very similar to a cellular blue nevus observed in the gluteus region of a 31-year-old male patient.

A natureza pode oferecer elementos passíveis de comparação com algumas lesões dermatológicas, como a semelhança entre a pérola negra e o nevo azul celular observado na região glútea de paciente do sexo masculino, 31 anos.