Bilateral posterior circulation stroke secondary to a crotalid envenomation: case report

Snake bite envenoming is a disease with potential serious neurological complications. We report a case of an adolescent who was bitten by a rattlesnake and developed bilateral posterior circulation stroke. The rattlesnake was later identified as being Crotalus durissus terrificus. Stroke was probably due to toxic vasculitis or toxin-induced vascular spasm and endothelial damage.

Bilateral giant renal angiomyolipoma associated with hepatic lipoma in a patient with tuberous sclerosis

OBJECTIVE: To report a case of bilateral giant renal angiomyolipoma associated with tuberous sclerosis, with successful treatment, and to review the literature concerning angiomyolipoma treatment. CASE REPORT: Patient with tuberous sclerosis and angiomyolipoma diagnosed by ultrasonography during her pregnancy. At that time, the angiomyolipoma on the right side was 9 cm in diameter. Conservative management was selected during her pregnancy. The patient returned 7 years later, with a 24.7 x 19.2 x 10.7 cm tumor on the right side and another of 13 x 11.5 x 6.5 cm on the left side, in addition to multiple small angiomyolipomas. A nephron-sparing surgery with tumoral enucleation was performed on the right side, and after 3 months, the tumor on the left side was removed. Renal function in the post-operative period was preserved, and contrast medium progression was uniform and adequate in both kidneys. CONCLUSION: We conclude that an angiomyolipoma larger than 4 cm should be removed surgically, since they have a greater growth rate and pose a risk of hemorrhage. Resection of smaller tumors is safe and has decreased morbidity. Tumoral enucleation is an effective treatment method that preserves kidney function.

Density-dependent morphological plasticity and trade-offs among vegetative traits in Eichhornia crassipes (Pontederiaceae)

Density-dependent responses are an important component of the organism life-history, and the resource allocation theory is a central concept to the life-history theory. When resource allocation varies due to environmental changes, a plant may change its morphology or physiology to cope with the new conditions, a process known as phenotypic plasticity. Our study aimed to evaluate how plant density affects Eichhornia crassipes allocation patterns. A total of 214 individuals in high and low density were collected. The density effect was observed in all plant traits examined including biomass accumulation. All traits of E. crassipes demonstrated higher values in high density conditions, except for biomass of leaves. Density exhibited a high influence on vegetative traits of E. crassipes, but did not influence allocation pattern, since a trade-off among the vegetative traits was not found. The morphological plasticity and the absence of trade-offs were discussed as strategies to overcome neighbor plants in competition situations. In high density conditions, there were clear changes in the morphology of the plants which probably allows for their survival in a highly competitive environment.

Glaucoma agudo bilateral por uso de topiramato: relato de caso

O topiramato, uma sulfa monossacarídica, usada primariamente como um anticonvulsivante, é uma droga relativamente nova no mercado brasileiro. Devido às potencialidades terapêuticas do topiramato em uma gama variada de patologias (enxaquecas, transtornos do humor, etc.), assim como pelas diversas novas apresentações comerciais surgidas no país ultimamente, espera-se que seu uso venha a ser cada dia mais comum. O presente relato se refere a um grave efeito colateral decorrente do uso da medicação em questão, ocorrido em um homem de 36 anos - o glaucoma agudo bilateral, evento ainda pouco relatado na literatura mundial. Por conta de tal quadro, o paciente teve de se submeter a uma iridotomia bilateral.

Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.

Bilateral carotid endarterectomy combined with myocardial revascularization during the same surgical act

The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease still remains controversial. In this report we present a case of a 72-year-old female patient admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe bilateral carotid artery stenosis were diagnosed. A combined, simultaneous surgical procedure was performed. After total circulatory by-pass with a membrane oxygenator, the patient's body temperature was lowered to 32°C. During the cool-down period, three proximal anastomoses of segments of autologous saphenous veins were performed in the ascending aorta. Immediately afterwards, bilateral carotid endarterectomy was performed, followed by three distal anastomoses to coronary arteries. The patient showed a satisfactory post-operative outcome. It was concluded that the combination of moderate hypothermia, hemodilution with appropriate hemodynamic control, as used in this patient, was an effective method of cerebral protection. The simultaneous approach of carotid endarterectomy and coronary artery by-pass surgery should be seen as a safe option for the treatment of this type of patient.

Cirurgia de revascularização miocárdica: uso de enxerto bilateral de artéria torácica interna sem circulação extracorpórea

FUNDAMENTO: Avanços na cirurgia de revascularização miocárdica (RM) introduziram benefícios adicionais, como a técnica sem uso da circulação extracorpórea (CEC) e a utilização do enxerto bilateral de artéria torácica interna (ATI). A cirurgia de RM sem uso da CEC tem sido associada a melhora dos resultados imediatos e a redução da incidência de complicações perioperatórias, e o uso bilateral de enxertos de ATI oferece aumento de sobrevida e redução de eventos cardiovasculares a longo prazo. OBJETIVO: Apresentar a experiência inicial com o emprego combinado desses avanços na cirurgia de RM. MÉTODOS: Foram estudados 35 pacientes consecutivos submetidos a RM sem CEC, com enxertos bilaterais de ATIs, sendo a ATI esquerda dirigida para a artéria descendente anterior e a ATI direita anastomosada aos ramos da artéria circunflexa. As co-morbidades predominantes foram infarto do miocárdio prévio em 71,4% dos pacientes, diabetes melito em 34,2% e insuficiência renal em 14,2%. RESULTADOS: Nenhum paciente apresentou alteração do eletrocardiograma ou elevação enzimática no pós-operatório. O número de pontes por paciente variou de 2 a 4 (mediana de 3 pontes/paciente). A permanência hospitalar pós-operatória esteve entre 3 e 12 dias (média de 4,7 + 1,7 dias). Não houve casos de infecção ou deiscência esternal, mas um paciente apresentou acidente vascular cerebral no quarto dia de pós-operatório e faleceu. A duração do seguimento tardio foi de 4 a 48 meses. Não houve óbitos tardios, 31 pacientes estão assintomáticos e 3 têm angina residual. CONCLUSÃO: A combinação desses avanços técnicos na cirurgia de revascularização cirúrgica mostrou-se eficaz e pode contribuir para a melhora dos benefícios a longo prazo.

Grande fístula bilateral da artéria coronária: a escolha do tratamento clínico

Relatamos o caso de um paciente do sexo feminino, assintomática, com grande fístula bilateral da artéria coronária-artéria pulmonar. O monitoramento clínico foi a opção escolhida para tratamento. Discutimos os pormenores das opções terapêuticas, enfatizando a tendência excessiva de utilizar a abordagem cirúrgica e a grande escassez de acompanhamentos clínicos de longo prazo em pacientes assintomáticos.

Ecological relations between mangrove leaf litter and the spatial distribution of the gastropod Melampus coffeus in a fringe mangrove forest

Leaf litter represents a food source to many organisms that may directly contribute to organic matter decomposition. In addition, the physical presence of these vegetal detritus contributes for the modification of some environmental areas and produce microhabitats that may act as a refuge against predators and desiccation for many animals. The pulmonate gastropod Melampus coffeus (Linnaeus, 1758) (Ellobiidae) is a very common specie in Atlantic Coast mangrove forests and feeds on fallen mangrove leaves. It was hypothesized that the spatial distribution of Melampus coffeus is directly affected by mangrove leaf litter biomass deposition. Thus, this research aimed at evaluating the spatial distribution of these gastropods in relation to the biomass of mangrove leaf litter through a twelve-month period. The study area was established in the middle estuary of Pacoti River, state of Ceará, Brazil where two adjacent zones with different topographic profiles were determined. Samples of Melampus coffeus and leaf litter were collected monthly, throughout a year, from the mangrove ground surface. The results indicated that the presence of twigs in mangrove litter favor the occupation by smaller individuals of M. coffeus, probably because smaller individuals are more susceptible to predator attacks and desiccation than larger ones, and twigs and branches may provide a safe microhabitat.

Detection of Onchocerca volvulus (Nematoda: Onchocercidae) infection in vectors from Amazonian Brazil following mass Mectizan™ distribution

Detection of Onchocerca volvulus in Simulium populations is of primary importance in the assessment of the effectiveness of onchocerciasis control programs. In Brazil, the main focus of onchocerciasis is in the Amazon region, in a Yanomami reserve. The main onchocerciasis control strategy in Brazil is the semi-annually mass distribution of the microfilaricide ivermectin. In accordance with the control strategy for the disease, polymerase chain reaction (PCR) was applied in pools of simuliids from the area to detect the helminth infection in the vectors, as recommended by the Onchocerciasis Elimination Program for the Americas and the World Health Organization. Systematic sampling was performed monthly from September 1998 to October 1999, and a total of 4942 blackflies were collected from two sites (2576 from Balawaú and 2366 from Toototobi). The molecular methodology was found to be highly sensitive and specific for the detection of infected and/or infective blackflies in pools of 50 blackflies. The results from the material collected under field conditions showed that after the sixth cycle of distribution of ivermectin, the prevalence of infected blackflies with O. volvulus had decreased from 8.6 to 0.3% in Balawaú and from 4 to 0.1% in Toototobi.

Sharing competences in strategic alliances: a case study of the Cosan and Shell biofuel venture

In a competitive world, the way a firm establishes its organizational arrangements may determine the enhancement of its core competences and the possibility of reaching new markets. Firms that find their skills to be applicable in just one type of market encounter constraints in expanding their markets, and through alliances may find a competitive form of value capture. Hybrid forms of organization appear primarily as an alternative to capturing value and managing joint assets when the market and hierarchy modes do not present any yields for the firm's competitiveness. As a result, this form may present other challenging issues, such as the allocation of rights and principal-agent problems. The biofuel market has presented a strong pattern of changes over the last 10 years. New intra-firm arrangements have appeared as a path to participate or survive among global competition. Given the need for capital to achieve better results, there has been a consistent movement of mergers and acquisitions in the Biofuel sector, especially since the 2008 financial crisis. In 2011 there were five major groups in Brazil with a grinding capacity of more than 15 million tons per year: Raízen (joint venture formed by Cosan and Shell), Louis Dreyfus, Tereos Petrobras, ETH, and Bunge. Major oil companies have implemented the strategy of diversification as a hedge against the rising cost of oil. Using the alliance of Cosan and Shell in the Brazilian biofuel market as a case study, this paper analyses the governance mode and challenging issues raised by strategic alliances when firms aim to reach new markets through the sharing of core competences with local firms. The article is based on documentary research and interviews with Cosan's Investor Relations staff, and examines the main questions involving hybrid forms through the lens of the Transaction Cost Economics (TCE), Agency Theory, Resource Based View (RBV), and dynamic capabilities theoretical approaches. One focal point is knowledge "appropriability" and the specific assets originated by the joint venture. Once the alliance is formed, it is expected that competences will be shared and new capabilities will expand the limits of the firm. In the case studied, Cosan and Shell shared a number of strategic assets related to their competences. Raízen was formed with economizing incentives, as well to continue marshalling internal resources to enhance the company's presence in the world energy sector. Therefore, some challenges might be related to the control and monitoring agents' behavior, considering the two-part organism formed by distinctive organizational culture, tacit knowledge, and long-term incentives. The case study analyzed illustrates the hybrid arrangement as a middle form for organizing the transaction: neither in the market nor in the hierarchy mode, but rather a more flexible commitment agreement with a strategic central authority. The corporate governance devices are also a challenge, since the alignment between the parent companies in the joint ventures is far more complex. These characteristics have led to an organism with bilateral dependence, offering favorable conditions for developing dynamic capabilities. However, these conditions might rely on the partners' long-term interest in the joint venture.

The evolution of universities' relations with the business sector in Brazil: What national publications between 1980 and 2012 reveal

ABSTRACT This paper addresses the changes in university-industry relations in Brazil regarding innovation activities. It is based on a survey of articles published in major national journals or presented at the most relevant Brazilian and regional conferences, between 1980 and 2012. The year 1980 was chosen due to the creation of the Technological Innovation Offices (NITs), which was the first government initiative to encourage knowledge transfer from universities to companies; the second was the Innovation Act of 2004. Our assumption was that after the Act the number of academic papers on this subject would increase, bringing new ideas and propositions of models to enhance this relationship. The methodology employed a qualitative, exploratory approach, using bibliographical research and a bibliometric analysis of 247 papers. Literature review of international studies shows the discussion of problems and suggestions for improvements, while in Brazil there is still a debate on whether this collaboration should occur, and if this is a legitimate role for the university. Despite the numerical growth, the content analysis showed few papers on new configurations and procedures for partnership management. We conclude that university-industry relations are not a regular and totally accepted process in Brazilian public universities, which reflect an ideological bias against cooperation with firms.