Botulinum toxin A in complex incisional hernia repair: a systematic review.

PURPOSE: To evaluate the safety, efficacy, and short and long-term postoperative results of using BTA. METHODS: We conducted a systematic review following the recommendations of the PRISMA method. We systematically reviewed the MEDLINE/PubMed and SCOPUS electronic databases for studies published between January 2010 and September 2021. This systematic review was registered in PROSPERO, with registration number CRD42021252445. RESULTS: After applying the selection criteria, 11 relevant articles were selected. The total sample size was 1058 patients. Most studies aimed to assess the rate of fascial closure, followed by the rate of recurrence and reporting of postoperative complications, as well as the need for the components separation technique (CST). None of the studies reported serious complications from using BTA. Regarding fascial closure, all articles had rates above 75%, except for one. Surgical site events ranged between 19% and 29.4%. No recurrence in the group that used BTA was recorded in five studies. The other articles reported recurrence rates ranging from 6.4 to 11.4% in the groups that received BTA. The studies had varying follow-up times ranging from 1 to 49 months, with a mean of 18.6 months (± 11.2). CONCLUSION: This review described most of the key points about the preoperative use of BTA in hernia repair. It can be concluded that the use of BTA is a safe and effective practice that promotes good short and long-term results. However, the limitations of the current literature prevent more accurate conclusions on the subject.

Análise evolutiva da morfologia e da irrigação do timo de javalis (Sus scrofa Linnaeus, 1758) / Evolutionary analysis of morphology and irrigation of the thymus of boar's (Sus scrofa Linnaeus, 1758)

Objetivou-se descrever comparativamente as artérias responsáveis pela irrigação dos lobos tímicos cervicais e torácicos dos javalis, determinando-se também as características morfológicas do referido órgão nessa espécie, a ponto de correlacioná-las evolutivamente com os demais representantes da família Suidae. Os lobos tímicos cervicais direito e esquerdo receberam ramos distribuídos pelas artérias carótidas comuns direita e esquerda e cervicais superficiais direita e esquerda e, por vezes, pelas artérias torácica externa esquerda e subclávia esquerda. Essa característica vascular foi mantida ao longo da evolução, estando presente em linhagens e raças mais recentes de suídeos. A irrigação dos lobos tímicos torácicos direito e esquerdo foi realizada predominantemente por ramos diretos e indiretos ipsilaterais e contralaterais das artérias torácicas internas direita e esquerda, e também por ramos da artéria subclávia esquerda. Ramos diretos das artérias cervicais superficiais direita e esquerda e ramos diretos da artéria torácica interna direita foram encontrados para o lobo tímico médio, sendo essa uma descrição única nessa espécie, o que demonstra uma característica evolutiva primitiva nesse ancestral.(AU)

The objective of this study was to comparatively describe the arteries responsible for the irrigation of the cervical and thoracic thymus lobes of Boars, also determining the morphological characteristics of this body in this species to the point of evolutionarily correlating them with other representatives of the Suidae family. The left and right cervical thymic lobes received branches distributed by common right and left, superficial right and left carotid arteries, and neck and, sometimes, the outer left chest and left subclavian arteries. This feature was vascular maintained throughout evolution and is present in more recent strains and breeds of swine. Irrigation of the right and left thoracic thymic lobes was performed predominantly by direct and indirect ipsilateral and contralateral branches of the right and left internal thoracic arteries and also by branches of the left subclavian artery. Direct branches of the right and left superficial cervical artery and right branches of the right internal thoracic artery were found for the average thymic lobe, this being a unique description in this species, demonstrating a primitive feature in this evolutionary ancestor.(AU)

Evolutionary aspects on the origin, distribution and ramifications of the ischiadicus nerve in the giant anteater (Myrmecophaga tridactyla) / Aspectos evolutivos sobre as origens, distribuições e ramificações dos nervos isquiáticos do tamanduá-bandeira (Myrmecophaga tridactyla)

This work aimed to describe the origin, distribution, and ramifications of the ischiadicus nerve in the giant anteater and to provide anatomical data which could explain not only the evolutionary aspects but also provide important information for other related works. For the present study, four specimens were used, prepared by perfusion of 10% formaldehyde solution via the femoral artery, for conservation and dissection. The origin of the right and left ischiadicus nerves in the giant anteater from the ventral ramification of the third lumbar (L3) and the first (S1), second (S2), and third (S3) sacral spinal nerves. These nerves were symmetrical in all animals studied. The distribution and ramification occurred to the superficial, middle, and deep gluteal, gemelli, piriform, quadratus femoris, tensor fasciae latae, caudal crural abductor, cranial and caudal parts of the biceps femoris, adductor, semitendinous, and cranial and caudal parts of the semimembranous muscles. Based on the origins of the ischiadicus nerves, there is a caudal migration in the nerve location in animals in a more recent position on the evolutionary scale due to reconfiguration of the lumbosacral plexus, resulting from the increase in a number of lumbar vertebrae. There is no complete homology of the muscle innervation.(AU)

Objetivou-se descrever as origens, distribuições e ramificações dos nervos isquiáticos no tamanduá-bandeira, disponibilizando, assim, dados anatômicos que possam não só elucidar os aspectos evolutivos como também fornecer informações importantes para áreas afins. Foram utilizados quatro espécimes preparados por meio da perfusão de formaldeído 10% via artéria femoral, para conservação e dissecação. As origens dos nervos isquiáticos direito e esquerdo no tamanduá-bandeira foram provenientes dos ramos ventrais dos nervos espinhais lombares três e sacrais um, dois e três, sendo simétricos em todos os animais estudados. As distribuições e ramificações ocorreram nos músculos glúteos superficial, médio e profundo; gêmeo; piriforme; quadrado femoral; tensor da fáscia lata; abdutor crural caudal; bíceps femoral parte cranial; bíceps femoral parte caudal; adutor; semitendíneo; semimembranáceo parte cranial e semimembranáceo parte caudal. Notou-se que houve uma migração caudal na localização deste nervo nos animais mais recentes na escala evolutiva, devido a uma reconfiguração do plexo lombossacral decorrente do aumento no número de vértebras lombares, não havendo uma homologia total quanto à inervação dos músculos.(AU)

Diet and feeding behavior of the White-naped Jay, Cyanocorax cyanopogon (Wied, 1821) (Aves, Passeriformes, Corvidae) in a disturbed environment in central Brazil.

The White-naped Jay Cyanocorax cyanopogon (Wied, 1821) is an omnivorous and opportunistic species, with a multifarious diet. In view of the scarcity of available data in the literature, the aim was to investigate and describe the bird's diet, location of food items, foraging tactics, actual feeding behavior and intraspecific interactions, as a means of defining the items consumed. The study was carried out in a Cerrado area in the Araguaia Campus of the Federal University of Mato Grosso - UFMT, in Pontal do Araguaia, Mato Grosso State, Brazil, from August to December, 2006, and from April to October, 2010. All the feeding events were recorded through 136 hours of animal focal sampling, whereby it was shown that these birds predominantly consume animal nutrients, replenished by vegetable items and human food-waste. Arthropods were predominant in the diet, with ants as the most abundant and frequent item. The fruits, flowers and seeds of eleven plant species were also consumed. Food-waste, representing about 1/10 of the total, was constantly consumed even when other food sources were available. Although active among the various strata, foraging is mainly on the ground. In the event of food-scarcity, the strategy employed is the hierarchical deployment of the members of various-sized groups, with the avoidance of direct competition. This versatility during all seasons, confirms total adaptation to the anthropic environment surrounded by native habitats that characterized the study site.

[Hereditary familial non polypoid colorectal cancer]. / Cáncer colorectal heredofamiliar no polipoideo.

The most common form of hereditary CRC is hereditary non-polyposis colorectal cancer (HNPCC), several mutator genes have been identified in this syndrome. The molecular genetic discoveries are providing news insights into the pathogenesis of CRC. The CRC in Lynch syndrome shows microsatellite instability and it also shows a special histology now referred to as an undifferentiated medullary or solid cribriform carcinoma. This histology is uncommon in various populations. In addition CRC in HNPCC shows an excess of mucoid features as well as peritumoral lymphocyte infiltration and Crohn-like reaction. It is very important to make a diagnosis based on the natural history features of a particular cancer syndrome in combination with a well orchestrated family history. We report the case of a 44 year old man with colon cancer and adenomatous polyps, without family history of adenomatous polyps but with familial antecedent of colon cancer in his father, with a suspicion of Lynch syndrome.

Two family members with a syndrome of headache and rash caused by human parvovirus B19.

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

Cáncer colorectal heredofamiliar no polipoideo / Hereditary familial non polypoid colorectal cancer

El CCRHNP es la forma más común de cáncer hereditario y representa aproximadamente el 15 % de todos los cánceres colorectales. En este artículo se destaca, a partir de un caso probable de presentación atípica, la importancia de los antecedentes familiares, la histología típica del tumor, la reacción inflamatoria peritumoral simil enfermedad de Crohn, la investigación de la inestabilidad microsatelital, el defecto genético de los genes MMR y la recomendación de um screening apropiado para el estudio de estos pacientes. Finalmente se destaca la posibilidad de lograr mayor difusión a nivel nacional sobre los centros donde se pueda realizar los estudios genéticos que permitan detectar portadores de esta enfermedad: asimismo al formación de grupos de estudio nos van a permitir obtener estadísticas propias, proyectar trabajos conjuntos y elaborar campañas de prevención. (AU)

Cáncer colorectal heredofamiliar no polipoideo / Hereditary familial non polypoid colorectal cancer

El CCRHNP es la forma más común de cáncer hereditario y representa aproximadamente el 15 % de todos los cánceres colorectales. En este artículo se destaca, a partir de un caso probable de presentación atípica, la importancia de los antecedentes familiares, la histología típica del tumor, la reacción inflamatoria peritumoral simil enfermedad de Crohn, la investigación de la inestabilidad microsatelital, el defecto genético de los genes MMR y la recomendación de um screening apropiado para el estudio de estos pacientes. Finalmente se destaca la posibilidad de lograr mayor difusión a nivel nacional sobre los centros donde se pueda realizar los estudios genéticos que permitan detectar portadores de esta enfermedad: asimismo al formación de grupos de estudio nos van a permitir obtener estadísticas propias, proyectar trabajos conjuntos y elaborar campañas de prevención.

Cáncer colorectal heredofamiliar no polipoideo. / [Hereditary familial non polypoid colorectal cancer]

The most common form of hereditary CRC is hereditary non-polyposis colorectal cancer (HNPCC), several mutator genes have been identified in this syndrome. The molecular genetic discoveries are providing news insights into the pathogenesis of CRC. The CRC in Lynch syndrome shows microsatellite instability and it also shows a special histology now referred to as an undifferentiated medullary or solid cribriform carcinoma. This histology is uncommon in various populations. In addition CRC in HNPCC shows an excess of mucoid features as well as peritumoral lymphocyte infiltration and Crohn-like reaction. It is very important to make a diagnosis based on the natural history features of a particular cancer syndrome in combination with a well orchestrated family history. We report the case of a 44 year old man with colon cancer and adenomatous polyps, without family history of adenomatous polyps but with familial antecedent of colon cancer in his father, with a suspicion of Lynch syndrome.

[The joint manifestations of exanthematous viroses]. / Manifestações articulares nas viroses exantemáticas.

The frequency of arthropathy was evaluated in 251 patients with clinical and serological diagnosis (specific IgM detection by enzyme immunoassay) of exanthematous disease. Arthropathy (arthralgia and/or arthritis) was more frequent in dengue fever (49%) and rubella (38.2%) cases than in human parvovirus (30%) and measles (28.1%) cases. Except for measles cases, joint complaints prevailed in adults (> or = 15 years of age) and this difference was significant. The higher frequency of arthropathy in adults was more evident in human parvovirus (75%), rubella (65%) and dengue fever (57.7%) cases than in measles cases (31%). Arthropathy was also more frequent in females for all rash diseases studied. The results of this study showed the high occurrence of joint complaints in the disease described here and the importance of laboratory confirmation for their differential diagnosis.

[Meningococcemia complicated by myocarditis]. / Meningococcemia complicada por miocardite.

We report a case of a 26-year old man with meningococcemia complicated with myocarditis (ventricular dysfunction and myocardial ischemia), that required treatment for heart failure. Regression of myocardial dysfunction was observed six months after the infection.

Meningococcemia complicada por miocardite / Meningococcemia complicated by myocarditis

Homem de 26 anos com meningococcemia (meningite), complicada por miocardite (disfunçäo ventricular e isquemia miocárdica), requereu tratamento para insuficiência miocárdica, seis meses após o quadro infeccioso

Variacao anatomica do plexo infra-orbital. Relato de um caso. / Anatomical variation of the infra-orbital plexus. Report of a case

Os autores relatam um caso de variacao anatomica do plexo infra-orbital em uma cirurgia do seio maxilar. Ressaltam a possibilidade do encontro de estruturas vizinhas ao antro dentro desta, e comentam a anatomia e variacoes do plexo infra-orbital. Salientam a necessidade de um exame pre-operatorio detalhado da cavidade sinusal, antes de um procedimento cirurgico a este nivel. O intuito e o de preservar estruturas anatomicas que porventura estejam no interior do seio maxilar

Associacao sulfametoxipirazina-trimetoprim no tratamento de afeccoes cronicas em otorrinolaringologia. / Sulfamethoxy razine-trimethoprim association in the treatment of chronic affections in otorhinolaryngology

Os autores apresentam os resultados obtidos de um estudo feito em 25 pacientes com afeccoes cronicas otorrinolaringologicas (otites medias, sinusites e faringites) submetidos a uma associacao medicamentosa a base de sulfametoxipirazina (SMPz) e trimetoprim (TMP), analisando a farmacodinamica e as vantagens desse tipo de associacao. A dose propostra foi de 200mg de SMPz e 250mg de TMP em administracao oral unica diaria por um periodo de 10 (dez) dias, sendo que a base foi o dobro no primeiro dia. O controle dos pacientes e analise dos resultados foram baseados principalmente nas manisfestacoes clinicas referidas pelos pacientes, associados a exames laboratoriais e radiologicos pertinentes a cada afeccao otorrinolaringocologica Foram obtidos resultados entre otimo e bom 18 casos (72%) e regular em 4 casos (16%) sendo que apenas 3 casos (12%) foram considerados insucessos. Conclui-se, pela porcentagem de bons resultados facilidade de posologia e boa tolerancia medicamentosa apresentada pelos pacientes que ha validade no emprego desta associacao na terapeutica de afeccoes cronicas otorrinolaringologicas