Incomplete ureteral quintuplication obstructed by proximal calculus: Case report and review of literature.

INTRODUCTION: Ureteral duplication is a common congenital anomaly, although multiple ureters is a rare disorder. Bifid ureter or multiple ureters are diagnosed incidentally and generally associated with obstruction by lithiasis. CASE PRESENTATION: We present a case of ureteral quintuplication converging into a sacculation obstructed by a 7 cm calculus. CONCLUSION: Two or more ureters are more common in women and it is mostly associated with asymptomatic presentation, excepting when related to complications of urinary tract infection or lithiasis. More than four ureters are extremely rare and our case is the first of incomplete quintuplication found so far in the literature.

Colovesical fistula in a young adult due to sigmoid colon diverticulitis undetected in computed tomography: Case report and review of literature.

INTRODUCTION: Colovesical fistula is the pathological communication between the colon and urinary bladder. It is related with high morbimortality rate and it is and uncommon complication of diverticulosis in young adults. CASE PRESENTATION: We report a case of a 38-year-old Brazilian man with fecaluria and pneumaturia for eight months, whose colovesical fistula was undetectable in CT scan and with surgical management. DISCUSSION: Diverticulosis is the main inflammatory condition causing colovesical fistulas and the sigmoid colon is the most common part involved. It is more prevalent in patients over 60 years old and in western countries due to low fiber diet. CONCLUSION: Colovesical fistula diagnosis is difficult, requiring high suspicious and proper investigation through good anamnesis, CT scan and also colonoscopy and cystoscopy when necessary.

Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review.

Phosphodiesterase type 5 inhibitors such as sildenafil citrate and tadalafil are well known for the treatment of erectile dysfunction. However, their use in the presence of pulmonary hypertension can cause ophthalmologic side effects, including non-arteritic optic ischemic neuropathy, chorioretinopathy, glaucoma, and optic atrophy. The present review aimed to identify these visual side effects and provide recommendations. We identified articles published from January 2000 to March 2019 on diseases arising from the management of sexual dysfunction in urology or pulmonary hypertension in pneumonia that could cause pathologic alterations in eye structure based on a literature search of the MEDLINE electronic database using keywords for the most common adverse effects and different kinds of phosphodiesterase 5 inhibitors. After applying the exclusion criteria, we selected 36 of the 77 articles initially identified to write the narrative review and added 20 additional articles to completely describe the pathological entities. Phosphodiesterase type 5 inhibitors can cause side effects in the eye including ocular surface abnormalities, increased intraocular pressure and glaucoma, uveitis, non-arteritic ischemic neuropathy, chorioretinopathy, retinal occlusion, and visual field changes. There is an increased need for well-performed studies to better understand these side effects, which are common due to the wide use of sildenafil.

Ruptured Aneurysm of the Sinus of Valsalva Causing Pulmonary Embolism: A Rare Association.

Aneurysms of the sinus of Valsalva are rare. Unruptured sinus of Valsalva aneurysm is usually asymptomatic and rarely presents as right ventricular outflow obstruction, myocardial infarction as a result of coronary artery compression, conduction disturbances, or endocarditis. They have only been reported as the presumed source of embolism in six cases. We report a patient with right sinus of Valsalva rupture to the right atrium and embolization of aneurysm contents to the pulmonary vasculature.

Surgical management of spontaneous post-partum bladder rupture in an Amazonian emergency hospital.

Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency and even more uncommon in the puerperium. Post-partum bladder rupture might be associated with fetal pressure on the not emptied bladder wall during labor. We report a case of SRUB three days after normal vaginal delivery with high values of creatinine and absence of hematuria, surgically managed in an emergency hospital in the Amazon.

When archives are missing, deciphering the effects of public policies and climate variability on the Brazilian semi-arid region using sediment core studies.

The northeastern region of Brazil is the most densely populated and biodiverse semi-arid regions of the planet. Effects of the natural climate variability and colonization on the landscape have been described since the beginning of the 16th century but little is known about their effects on natural resources. Climate projections predict temperatures above 40 °C and an increase in the number and duration of droughts at the end of the 21st century with strong societal impacts. Here, we analyze the influence of public policies, human activities and natural climate variability on the environment over the last 60 years. Our study is based on sedimentological and environmental reconstructions from two sediment cores collected in two dam lakes on the river Acaraú in the State of Ceará. Multiproxy analyses of both cores (inorganic geochemistry, pollen, charcoal, remote sensing) at an annual resolution showed that 1) at interannual scale composition and distribution of the dry forest (known as Caatinga) were not affected by the alternance of drought and high moisture episodes; 2) at decadal scale human activities such as agriculture were reflected by changes in vegetation cover and fishery by progressive changes in lake trophic status; 3) public policies were able to promote changes in the landscape e.g., land colonization with the regression of the dry forest and irrigation plan able to amplify the deforestation and change the floristic composition. Thanks to paleo-science approach, our environmental diagnosis should help future decision-making and provide guidelines for preservation of resources and wellbeing of the inhabitants.

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis.

BACKGROUND: This study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. METHODS: A total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. RESULTS: Most patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, ≥ 1 or high dose vasopressors and blood glucose. CONCLUSIONS: Some DMR variables were associated with DGF, suggesting a potential impact of variables reflecting poor clinical and hemodynamic status on the incidence of DGF.

Boari-Flap reconstrution due to a total ureteral avulsion in a patient with ipslateral ureterolithiasis and contralateral renal nodule.

The ureteral avulsion during ureterolithotripsy (URS) occurs due to the sudden movement of the optical device or endoscopic extractor either in its removal or insertion, associated with a probable previous lesion in the ureter wall, causing a vital fragility area. A 52-year-old male patient with, an obstructive calculus of 9 mm was found in the left middle ureter, and a heterogeneous hypervascular nodule located in the right kidney, suggesting neoplasia. During procedure with rigid ureteroscopy with ureteroscope removal, due to the pressure of the device and tissue fragility, there was total ureter avulsion.

Surgical treatment of testicular tumor and its difficult management with indigenous patient.

Case description of a male patient, 27 years old, native Brazilian, indigenous, deaf, with a significant growth of left testicle, painless, with infiltrations, insidious beginning and two years of evolution because of the difficulty of monitoring this type of population. Presented high serum level of lactate dehydrogenase (LDH), up to 20 times higher than the maximum reference value. Ultrasound of the testis showed a complex mass on the left testicle, not being able to give an estimate of the volume. The patient underwent a partial left scrotectomy, associated to radical left orchiectomy, showing an extended invasive testicular tumor and left inguinal lymphadenopathy. Histopathology was compatible with seminoma, weighting 2.600 g, with secondary implants on lungs, retroperitoneum and inguinal region, classified as Stage IIIC. The patient was referred to chemotherapy. Testicular tumor is approached as rare and this is one of the few of its descriptions with such size.

Surgical treatment of kidney tumor on a patient with second case of staghorn calculus and associated renal hydronephrosis: case report.

Staghorn, struvite or coral calculus are the ones that completely or partially occupies the renal pelvis and branches to the renal calices. The presence of renal calculi of any kind in the urinary tracts is related to the appearing of malign tumor in the kidneys, especially in the absence or failed treatment. A male patient, 51 years old, native of Manaus, reports about dysuria and polyuria associated with constant fever episodes and urinary tract infections with improvement by using several antibiotics but returning the symptoms after suspending it. The patient return was in a month and no improvement of the pain in the patient's feeling, with the tomography image tests result showing atrophy in the right kidney, which presents dilatation of the collector system, that it's filled with material with density varying between thick liquid and soft parts (average of 45 UH), in addition to calculus in the pelvis and ureteropelvic junction, suggesting a pattern for xanthogranulomatous pyelonephritis and matching previous history of right staghorn calculus. The association between kidney cancer and staghorn calculus should be consider through the treatment. Patients with renal diseases of severe prognosis in both kidneys must be kept under constant surveillance by the urology and nephrology team, the association of both clinics is essential to a fortunate ending like the case reported.

Large verrucous penis cancer in a young patient in the Brazilian Amazon: Case report and discussion on the region's reality.

INTRODUCTION: Penile cancer is a rare malignant tumour top in urology, especially in developed countries or in a favourable cultural habit. However, in developing countries or with a low socio-economic population, the incidence increases considerably, as does the stage at which the patient arrives for the first care. CASE PRESENTATION: Male patient, 20 years old, from the interior of Amazonas - Brazil, has been referred to a Urological Service in the Emergency Room due to a vegetative lesion of approximately 10 centimetres, with an ulcerated centre and irregular borders in penile glans. An incisional biopsy was performed, which revealed invasive squamous cell carcinoma and was referred to the elective surgery service. CONCLUSIONS: The socioeconomic condition of the population influences in a relevant way in cases in the Amazon region, with little and difficult access to preventive information and to the public health system, mainly in the interior of the state. Young patients tend to maintain the confidentiality of the picture that leads to the progression of the disease, with negative outcomes, requiring intense psychological monitoring.

Videolaparoscopic treatment of total migration of double j stent to renal pelvis as a complication of rigid ureterolitotripsy in a university hospital at Amazon.

The insertion of a double-j catheter in patients with urinary lithiasis is currently important because it reduces the chances of obstructive complications such as hydronephrosis and renal functional loss. The following case aims to show the patient evolution which presented the complete migration of the catheter to the renal pelvis and how it could complicate its prognosis. Placing a dual-catheter for treatment of lithiasis is a routine procedure in urology services but is not beyond complications during the process. Even with exhaustive complementary imaging exams, we must maintain a constant evaluation of the patient.

Effects of nonsteroidal anti-inflammatory drugs on osseointegration: a review.

The purpose of this study was to review the effects of nonsteroidal anti-inflammatory drugs on osseointegration and determine whether they cause failures in dental implants and whether patients who use them chronically can receive dental implants safely. A bibliographic electronic search was performed using the Cochrane Library, PubMed, and Medline databases, selecting articles published between January 1982 and December 2012. The search included the following keywords, either alone or combined: "nonsteroidal anti-inflammatory drugs," "dental implants," "bone healing," and "osteoprogenitor cells." The inclusion criteria were the following: randomized, double-blind, placebo-controlled clinical studies, in vivo animal model studies of osseointegration, and in vitro studies of the effects of these agents on osteoprogenitor cells. The literature search revealed 360 references. A total of 31 articles met the inclusion criteria, including 2 clinical trials, 20 animal studies, and 9 osteoprogenitor cell studies. The clinical trials revealed that cyclooxygenase-1 (COX-1) inhibitors did not impair osseointegration. The animal studies showed that any drug that is capable of inhibiting COX-2 may impair the osseointegration process. The in vitro studies showed that COX-2 inhibitors are the most potent depressors of osseointegration at the cellular level. Caution must be taken when selecting COX-2 nonsteroidal anti-inflammatory drugs during the postoperative period.

First ediacaran fauna occurrence in northeastern Brazil (jaibaras basin, ?ediacaran-cambrian): preliminary results and regional correlation.

This study reports the first known occurrence of the Ediacaran fauna in northeastern Brazil (at Pacujá Municipality, northwestern state of Ceará) and presents preliminary interpretations of its significance. Regional correlation indicates that the fossils originated in the Jaibaras Basin and that they may represent a new geological system. The depositional environment can be attributed to a fluviomarine system. Nine Ediacaran species can be identified, including members of pandemic groups (e.g., Charniodiscus arboreus Glaessner, 1959; ?Charniodiscus concentricus Ford, 1958; Cyclomedusa davidi Sprigg, 1947; Ediacaria flindersi Sprigg, 1947; and Medusinites asteroides Sprigg, 1949) and endemic groups (e.g., Kimberella quadrata Glaessner & Wade, 1966; Palaeophragmodictya reticulata Gehling & Rigby, 1996; Parvancorina minchami Glaessner, 1958; and Pectinifrons abyssalis Bamforth, Narbonne, Anderson, 2008). Three ichnogenera are also present: Arenicolites Salter, 1857; Palaeophycus Hall, 1987; and Planolites Nicholson, 1873. The relative age of the deposits is between ?Ediacaran and Cambrian, and the fauna resembles the White Sea Assemblage. The bioturbation presents typical unbranched Ediacaran ichnogenera with little depth in the substrate. This previously unknown occurrence of the Ediacaran fauna reinforces the importance of the state of Ceará to Brazilian and global palaeontology.

[Natural presence of Beauveria bassiana (Balsamo) Vuillemin in the sugar cane (Saccharum sp. hybrid) in Cuba]. / Presencia natural de Beauveria bassiana (Bals.) Vuill. en el cultivo de la caña de azúcar (Saccharum sp. hírido) en Cuba.

The natural presence of Beauveria bassiana was determined (Balsamo) Vuillemin from insects with mycotic symptoms collected in leaves and in the stalks of sugar cane (Saccharum sp. hybrid) in Pinar del Río, Ciudad de la Habana, Habana, Matanzas, Villa Clara, Cienfuegos and Camagüey. The results obtained demonstrate the natural presence of the entomopathogen fungus in larvae and chrysalises of Diatraea saccharalis (Fabricius) and they suggest the basis for the strategy of biological control against this borer.