The anterior sagittal transrectal approach (ASTRA) for cases associated with rectal implantation of the urethra: A retrospective review of six cases.

INTRODUCTION: Severe genital abnormalities such as urogenital sinus and urethral duplication with ectopic urethra in the rectum represent a major challenge in reconstructive urology. OBJECTIVE: We aimed to review our cases presenting with functional ectopic urethra implanted in the rectum that were treated through an ASTRA approach. METHODS: We reviewed the medical records of all patients who had undergone an ASTRA approach from 2005-2016. We collected data with interest to primary diagnosis, clinical presentation, additional procedure, immediate clinical outcome, complications, bowel habits after surgery, voiding and bladder emptying pattern and long term follow-up. RESULTS: Since 2005, we treated 6 cases using this method, consisting of 3 patients with congenital aphallia and 3 with Y-type urethral duplication. Two aphallia patients underwent De Castro's neophalloplasty with simultaneous anastomosis of proximal urethra to a tubed buccal mucosa neourethra and one had a neophalloplasty with transverse skin flaps and primary perineal urethrostomy. Two patients with Y-type urethral duplication had a complete urethroplasty performed (one end-to-end anastomosis and a two-stage repair). Last patient had a definitive perineal urethrostomy. At mean follow-up of 83.5 meses, only one patient voids through the urethra, four have a Mitrofanoff channel and two have a perineal urethrostomy. Immediate follow-up was uneventful and none of our patients had any bowel complications nor fecal incontinence. DISCUSSION: Domini et al. were the first proponents of the anterior sagittal transanorectal approach (ASTRA) as an alternative to classic Peña approach. Later, De Castro popularized specifically this technique as a relevant part of his neophalloplasty procedure to treat congenital aphallia. We did not find in this series any complications related to ASTRA technique in regards to bowel habits, fecal incontinence or infection but most of cases we tried to create a new anterior urethra and connect to the proximal stump failed. Moreover, we are skeptic to support simultaneous urethral repair when there is a dysplastic bulbar segment between the proximal stump and the end of the penile urethra normally at penoscrotal junction area by urethral duplication. Treatment at two-stages is also prone to fail in the midterm. At end, most of them will have either a Mitrofanoff or perineal urethral stoma as shown in our data. CONCLUSION: The ASTRA approach proved to be useful for cases of rectal implantation of the urethra. No complications related to anterior sphincter incision were documented. We believe it should be regarded as the treatment of choice for cases alike ours.

Avaliação da composição e qualidade físico-química do leite pasteurizado padronizado comercializado na cidade de São Luís, MA / Evaluation of the composition and physical and chemical quality of standardized pasteurized milk marketed in the city of São Luís, MA, Brazil

Objetivou-se com este estudo avaliar a composição e a qualidade físico-química do leite pasteurizado padronizado comercializado na Cidade de São Luis, MA, verificar se estavam dentro dos padrões estabelecidos pela Instrução Normativa nº 51 do Ministério da Agricultura, Pecuária e Abastecimento e observar a ocorrência de fraudes econômicas como adição de água, através da densidade e crioscopia. Foram coletadas 20 amostras de leite pasteurizado padronizado durante o mês de maio de 2009, no comércio local da cidade. Foram realizadas análises de acidez, densidade, índice crioscópico, EST, ESD, proteína, gordura, cinzas, prova de peroxidase e fosfatase alcalina. Das 20 amostras analisadas, verificou-se que a densidade variou de 1,020 a 1,027 g/mL; a acidez de 10 a 14ºD; a gordura de 2,5 a 3,8%; o EST de 8,6 a 11,36%; ESD 6,1 a 7,86%; crioscopia 0,414 a 0,505ºC; proteínas de 2,4 a 3,32% e cinzas de 0,49 a 0,95%, a % de água adicionada variou de 1,27 a 17,83%. Todas as amostras apresentaram fosfatase negativa e peroxidase positiva. Com relação aos resultados obtidos, pode-se concluir que se apresentaram de forma geral insatisfatórios, evidenciando, principalmente, fraude do produto. Portanto, torna-se necessária a adoção de medidas de fiscalização por parte das autoridades competentes e maior conscientização das indústrias e consumidores.

The objective of this study to evaluate the composition and physico-chemical quality of standardized pasteurized milk marketed in São Luis, MA, Brazil, verify whether it was within the standards established by Instruction No. 51 of the Ministry of Agriculture, Livestock and Supply, and observe the occurrence of any economic fraud such as adding water, by measuring the density and freezing point. We collected 20 samples of standardized pasteurized milk during the month of May 2009, at a local town market. These were analyzed for acidity, density, cryoscopy, TS, SNF, protein, fat, ash, proof of peroxidase and alkaline phosphatase. Of the 20 samples analyzed, it was found that the density ranged from 1.020 to 1.027 g/mL; acidity from 10 to 14°D; fat from 2.5 to 3.8%; TS 8.6 to 11.36%; SNF 6.1 to 7.86%; freezing point 0.414 to 0.505°C; proteins from 2.4 to 3.32%; ash 0.49 to 0.95%; while the percentage of water added ranged from 1.27 to 17.83%. All samples were phosphatase negative and peroxidase positive. Regarding the results obtained, we can conclude that they were generally poor, showing mainly product fraud. Therefore, it is necessary to adopt measures for control by the relevant authorities and to raise awareness within the industries and among consumers.

Freqüência de cães reagentes para Neospora caninum em São Luís, Maranhão / Frequency of Neospora caninum in dogs from São Luís, Maranhão

The frequency of antibodies to Neospora caninum (Protozoa: Apicomplexa) in dog sera was investigated. Blood samples from 100 mongrel dogs, captured in the streets of São Luís, State of Maranhão, were analized using imunofluorescent antibody test. Forty five percent of the dogs were positive, and the titers ranged from 1:50 to 1:800. No sex difference was observed for frequency of N. caninum (60 percent in males and 40 percent in females). This is the first report of antibodies to N. caninum in dogs from Maranhão.

Contribuiçåo da medicina complementar para a integralidade da assistência das ações de educaçåo em saúde da Unidade de Saúde da Família de Nazaré-Inabi, nos grupos de hipertensos e diabéticos / Contribution of complementary medicine to integrate assistance of helth education actions in Nazaré-Inabi's Family Health Unit, in hypertensive and diabetic groups

Estresse, correria, poluiçåo e preocupações såo alguns dos problemas da vida moderna que mexem com a nossa saúde e tiram nossa energia. Atividades como a medicina complementar podem repor essa energia perdida, proporcionando a vitalidade, a calma, o alívio das dores, a melhoria da circulaçåo sangüinea e o tônus muscular, dentre outros benefícios. Este trabalho tem como objetivo apresentar a experiência com atividades de medicina complementar, inicidas em maio de 2002, dentro da ações de educaçåo em saúde, desenvolvidas na comunidade de Nazaré-Inabi, no município de Macaragibe. O trabalho ocorreu sob a orientaçåo dos profissionais da equipe e de convidados que realizam, em outros espaços, atividades com este fim.