Endovascular treatment of pseudoaneurysm of the thoracic aorta from a firearm injury

A 24-year-old male patient was the victim of a firearm wound that penetrated the thorax. He arrived at another hospital hemodynamically unstable and was submitted to exploratory surgery by means of bithoracotomy. A lesion of the left branch of the pulmonary artery was detected and successfully repaired. He was submitted for computer-aided tomography on the fifth postoperative day, and a lesion of the mid-thoracic aorta was detected, which formed a saccular image. Considering that the patient had already been submitted to a bithoracotomy and that a direct approach to repair would involve another thoracotomy within a short period of time, endovascular treatment was chosen in our hospital. The procedure was performed under fluoroscopy. A second computer-aided tomography indicated adequate treatment of the lesion, with no indication of an endoleak. He has undergone ambulatory follow-up for 36 months without any problem related to the procedure. While endovascular treatment of the aorta has developed enormously, multicenter studies are needed to better define the long-term results of this approach. © 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Endaural access to remove the projectile from a firearm

Background: Surgical approaches to temporomandibular region have been the subject of numerous controversies in the literature. Pre-auricular approaches have been used with the observance of high success rate, and during surgery history, various modifications of this approach were conducted in order to reduce irreversible sequelae. Thus, given the relevance of the study, this article proposes to alert the professionals that carry out these surgical approaches in relation to the anatomical structures involved and to describe and emphasise the benefits of endaural approach. Case report: A Caucasian male patient, victim of a firearm injury, sustained a wound on the right pre-auricular region, and at the time of assessment, he complained of pain, mouth opening difficulty and dysphagia. On physical examination, there was oedema and ecchymosis in the right periorbital region. In the radiological examination, a foreign body compatible with a firearm projectile was observed in the right pre-auricular region, being in accordance with the information collected. The endaural incision and divulsion by plans was then made until the projectile. Discussion: For proper exposure of the region, several studies were designed to evaluate the patterns of branching and anastomosis of the facial nerve. As for the best cosmetic result with the different pre-auricular approaches, the endaural approach was described as an approach that offers great cosmetic results because the incision design guides the surgeon in the wound closure and causes a decrease in the tension of flap, unlike that observed by some authors. © 2012 Springer-Verlag Berlin Heidelberg.

Clonidina como droga adjuvante no tratamento da síndrome de abstinência alcoólica em unidade de terapia intensiva: relato de caso

JUSTIFICATIVA E OBJETIVOS: A sedação de dependentes de álcool e drogas em Unidades de Terapia Intensiva (UTI) é um desafio pela elevada incidência de tolerância às drogas sedativas e da elevada freqüência de síndromes de abstinência. O objetivo deste relato é mostrar um caso de paciente jovem admitido na UTI que desenvolveu síndrome de abstinência alcoólica e tolerância às drogas sedativas, solucionadas somente após o uso de clonidina. RELATO do CASO: Paciente do sexo masculino, 18 anos, dependente de álcool, tabaco, cocaína e maconha, vítima de acidente por arma de fogo, foi admitido na UTI no 1º dia de pós-operatório de enterectomia, após aspiração de conteúdo gástrico durante reintubação traqueal. Evolução clínica: drogas vasoativas até o 4º dia de internação e broncopneumonia bilateral com derrame pleural e necessidade de ventilação artificial até o 15º dia. O esquema de sedação inicial utilizado foi a associação de midazolam e fentanil. A partir do 4º dia, o paciente apresentou vários episódios de agitação psicomotora, mesmo com a associação de lorazepam no 6° dia. No 9° dia, o paciente recebeu as maiores doses dos fármacos, mas permanecia agitado. Optou-se pela associação de dexmedetomidina, que reduziu as doses das outras drogas em 35% e diminuiu a agitação. No 12° dia, o midazolam e a dexmedetomidina foram substituídos pela infusão de propofol, com piora do quadro. No 13° dia, foi associada clonidina ao esquema de sedação, com resolução do quadro de agitação. No 14° dia, o propofol foi suspenso, sendo mantida a infusão de fentanil e reintroduzida a infusão de midazolam, com doses respectivamente 75% e 65% menores em relação ao pico de uso destas drogas. No 15° dia, o paciente foi extubado e teve alta da UTI. CONCLUSÕES: A droga de escolha para o tratamento da síndrome de abstinência alcoólica é o benzodiazepínico. Entretanto, no presente relato, somente o uso adjuvante de clonidina conseguiu proporcionar tratamento adequado ao paciente.

Wastes released by tanneries at Patrocinio Paulista, São Paulo State, Brazil

This investigation was carried out within the Parana sedimentary basin, Brazil, and involved the sampling of sludge and residuary waters that were collected from reservoirs/decantation ponds settled in two tanneries situated at Patrocinio Paulista, São Paulo State Two samples from each tannery were collected, stored in appropriate flasks and transported to the LABIDRO for chemical analysis The LABIDRO (Laboratory of Isotopes and Hydrochemistry) of the Petrology Department at the Geosciences and Exacts Sciences Institute of UNESP is situated in Rio Claro city, about 240 km distant from the investigated area The data for residuary waters were compared with guideline values established by two different legislations (a) Rule No 12486 (NTA60) established in 20(th) October 1978 by São Paulo State for defining the potable water standards and (b) Register 997 published on 31 May 1976 that defines the permissible concentration limits in effluents to be released to water bodies (coastal, fresh or ground water) in São Paulo State The results confirmed that leather production is an activity with high environmental impact, despite improvements that may be achieved by tanneries

Hydrochemical evaluation of different spring waters for bottling

This investigation was carried out within the Parana sedimentary basin in São Paulo and Mato Grosso do Sul States, Brazil, and involved the sampling of different spring water samples with the purpose of evaluating their quality for bottling Several methods were utilized for acquiring the hydrochemical data, such as methyl orange end-point titration, potentiometry, ion selective electrodes, spectrophotometry, atomic absorption spectrophotometry and inductively coupled plasma spectrometry The results obtained for the analyzed samples were compared with the guideline values established by the São Paulo State and Brazilian Health Ministry legislations for defining the potable water standards The Brazilian Code for Mineral Waters that was established by Register 7841 published on 8 August 1945 was also taken into account for verifying if the spring waters are mineralized The hydrochemical data allowed the identification of anthropogenic and geogenic inputs of some constituents in most of the samples, which affected the water quality and did not allow them to be utilized for commercial purposes (bottling) The waters of these springs can only become appropriate for human consumption after previous chemical treatment

Hydrochemical evaluation of the quality of some Brazilian waters

This investigation was carried out within the Parane sedimentary basin and neighbourhood in Brazil and involved the sampling of different water types with the purpose of evaluating its quality. Several methods were utilized for acquiring the hydrochemical data and a novel technique has been developed for evaluating the gross alpha and beta radioactivities in water, through a combined gamma-alpha spectrometry technique. The results obtained for the analyzed samples were compared with the guideline values established by the São Paulo State and Brazilian Health Ministry legislations for defining potable water standards and for the prevention and control of pollution in the environment. The hydrochemical data allowed evaluation of diverse problems related to the interaction between society and the environment such as sugarcane production and the releases associated with gas stations suppliers. The geogenic input of sulfate in groundwater was also identified. The established radiometric technique was properly calibrated and successfully applied to the analysis of different water types utilized for human consumption.

Perfurações esofágicas

RACIONAL: Dentre as perfurações do trato gastrointestinal, as lesões do esôfago são as de pior prognóstico. OBJETIVO: Avaliar os aspectos etiológicos, diagnósticos e terapêuticos de pacientes com perfuração esofágica atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Avaliação retrospectiva de pacientes internados no período de janeiro de 1999 a dezembro de 2006. Foram estudados 24 pacientes (18 homens e 6 mulheres) com idade média de 52 anos. Os pacientes foram divididos em dois grupos de 12. O Grupo 1 compreendia os pacientes cuja perfuração ocorreu na evolução de câncer do esôfago e o Grupo 2 os pacientes com perfuração devida a causas diversas. No Grupo 2 as causas foram: procedimento endoscópico em três casos, fundoplicatura em três, ingestão de corpo estranho em dois, balão de Blackmore em um, ingestão de antiinflamatório em um, pós-operatório de diverticulectomia em um, ferimento por arma de fogo em um. O esôfago torácico foi o local mais acometido (12 pacientes no Grupo 1 e sete no Grupo 2. em cinco pacientes do Grupo 1 foi realizada entubação transtumoral e nos demais gastrostomia ou jejunostomia. No Grupo 2, o procedimento realizado nas perfurações do esôfago torácico foi esofagectomia. RESULTADOS: A mortalidade operatória no Grupo 1 foi de 25% e no Grupo 2 de 8,33%. Conclusão - a) A lesão do esôfago cervical apresenta, em geral, evolução favorável; b) a conduta cirúrgica, mesmo quando realizado em fase não precoce (primeiras 24 horas), resulta em boa resolução.

Measurements of gunshot residues by sector field inductively coupled plasma mass spectrometry - Further studies with pistols

The most popular handgun in Brazil is the single round-barrel caliber 0.38 revolver. In recent years, however, owing to the modernization of police arms and their availability on the legal and illicit markets, pistols have become increasingly popular and currently represent about 20% of police seizures. In a previous paper we presented a novel collection method for gunshot residues (GSR) using a sampling procedure based on ethylenediamine-tetraacetic acid (EDTA) solution as a complexing agent on moistened swabs with subsequent detection using sector field-high resolution-inductively coupled plasma-mass spectrometry (SF-HR-ICP-MS). In the present paper, we discuss the capability of this methodology to identify antimony (Sb), barium (Ba) and lead (Pb) on the hands of volunteers after shot tests with 9 mm and 0.40 in. caliber pistols. Two types of munitions were tested: 9 mm Taurus and clean range. The use of a technique with high sensitivity, such as SF-HR-ICP-MS, permits the identification of low concentrations (less than 1 mu g/L) of metals in firearm residue and constitutes a powerful tool in forensic science. We also discuss the importance of the sampling procedure, including collection from a different body part than the gun hand of the suspect. Comparison of the analytical data obtained allows clear discrimination between samples from the hands of shooters and non-shooters. (C) 2007 Elsevier B.V.. All rights reserved.

Ocular Reconstruction After Zygomatic Complex Fracture With Retention of a Foreign Body

Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.

Epidemiologic Evaluation of Mandibular Fractures in the Rio de Janeiro High-Complexity Hospital

The aim of this study was to gather data on trauma etiology and mandibular fracture localization in patients who presented at the General Hospital of Nova Iguacu, Rio de Janeiro, Brazil. From March 2007 to December 2008, 95 patients with mandibular fracture were registered in a medical form, at the Bucomax-illofacial Surgery Department of the General Hospital of Nova Iguacu, Rio de Janeiro, Brazil. Concerning mandibular fracture etiology, 21.05% were caused by motorcycle accidents, followed by interpersonal violence without use of weapons (punches, kicks, bumps with the head, blows with the elbow, etc) (16.84%) and interpersonal violence with firearm (14.73%). It was found that 52.63% of the patients had a single fracture line. The most affected fracture area was the parasymphysis (26.02%), followed by the condyle (22.60%) and mandibular angle (18.49%). Concerning the injury area, 24.21% were directed to the mandibular symphysis, 22.17% of the patients did not remember the injury area, and 18.94% had multiple injuries. When the injury was directed to the symphysis, the result was more condyle fractures (11.64%), and injuries at the mandibular angle resulted in fractures at the angle itself (8.90%). The most common fracture cause was traffic accidents, mainly motorcycle accidents, and the most affected areas were the parasymphysis and the condyle. The mandible isolated fractures occurred in half of the cases. Motorcycle accidents resulted in more fractures in the parasymphysis area, and when the symphysis area is affected by injuries, the result is a higher percentage in condyle fractures.

Is the environmental policies procedures a barrier to development of inland navigation and port management? A case of study in Brazil

The main objective of this article is to discuss the Brazilian environmental legislation and policies towards the development of navigation and port management. The research illustrated some difficulties faced by the country and make suggestions to overcome it. The construction of the environmental legal framework began in the early 1960s and resulted in a very complex system, as a consequence of policies adopted by the country. Nowadays Brazilian environmental policies are developed in democratic and participative way, although with elevated degree of bureaucracy and lack of integration among the several governmental agencies, which makes the approval of environmental certifications demand several years for new port projects or improvements, which delays the economic development of the country. Efforts have been made to simplify the licensing process. As result of this research two flowchart for environmental licenses of ports installation are shown: The first shows the process until 2009 and the second shows the process nowadays. This become an important issue due the fact that inland navigation is one of the less pollutant modes of transportation, and although, the process of environmental certification was simplified, if compare with 2009, it is still complex and time-consuming, delaying the development of the infrastructure. © 2012 Elsevier Ltd.

Análise dos processos de decomposição e sucessão ecológica em carcaças de suínos (Sus scrofa L.) mortos por disparo de arma de fogo e overdose de cocaína e protocolo de procedimento diante de corpo de delito

Pós-graduação em Biologia Geral e Aplicada - IBB

Análise de rótulos e bulas de agrotóxicos segundo dados exigidos pela legislação federal de agrotóxicos e afins e de acordo com parâmetros de legibilidade tipográfica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Políticas públicas, currículos e o processo de formação docente: um estudo sobre as configurações curriculares dos cursos de licenciatura em Física de uma Universidade pública

Pós-graduação em Educação para a Ciência - FC

A Disciplina história da matemática e a formação do professor de matematica: dados e circunstâncias de sua implantação na Universidade Estadual Paulista, campi de Rio Claro, São José do Rio Preto e Presidente Prudente

Pós-graduação em Educação Matemática - IGCE