Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

Efeito do treinamento físico aeróbio na reatividade vascular da artéria ilíaca em camundongos LDL-/-

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Soluções tipo vórtex em teorias de gauge Chern-Simons-Maxwell-Higgs

Pós-graduação em Física - IFT

Aspectos clássicos de teorias de segunda ordem

Pós-graduação em Física - IFT

Use of a gold microelectrode for discrimination of gunshot residues

Gunshot residues (GSR) can be used in forensic evaluations to obtain information about the type of gun and ammunition used in a crime. In this work, we present our efforts to develop a promising new method to discriminate the type of gun [four different guns were used: two handguns (0.38 revolver and 0.380 pistol) and two long-barrelled guns (12-calibre pump-action shotgun and 0.38 repeating rifle)] and ammunition (five different types: normal, semi-jacketed, full-jacketed, green, and 3T) used by a suspect. The proposed approach is based on information obtained from cyclic voltammograms recorded in solutions containing GSR collected from the hands of the shooters, using a gold microelectrode; the information was further analysed by non-supervised pattern-recognition methods [(Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA)]. In all cases (gun and ammunition discrimination), good separation among different samples in the score plots and dendrograms was achieved. (C) 2012 Elsevier B.V. All rights reserved.

Efeitos da Prostaglandina E1 na gênese de capilares sanguíneos em músculo esquelético isquêmico de ratos: estudo histológico e ultra-estrutural

Objetivo: o objetivo deste trabalho foi estudar os aspectos morfológicos e ultra-estruturais na gênese de capilares sanguíneos em músculo esquelético do membro caudal de ratos submetidos à isquemia sob a ação da Prostaglandina E1 (PGE1), administrada por via intramuscular ou endovenosa. Métodos: foram utilizados 60 ratos (Rattus norvegicus albinus), linhagem Wistar-UEM, distribuídos aleatoriamente em três grupos de 20, redistribuídos igualmente em dois subgrupos, observados no 7o e 14o dias, sendo um grupo controle onde apenas foi provocada a isquemia no membro, outro com a isquemia e a injeção da PGE1 via intramuscular (IM), e outro com a isquemia e a injeção da PGE1 endovenosa (EV). Para análise dos resultados, foram realizadas a coloração com hematoxilina & eosina (HE), a imuno-histoquímica e a microscopia eletrônica de transmissão (MET). Resultados: constatou-se um aumento estatisticamente significante no número de capilares nos subgrupos com o uso da PGE1 IM e EV, através da contagem nos cortes corados com HE. Houve marcação de capilares e vasos de maior calibre nestes mesmos subgrupos, porém, esta reação não foi eficiente para a quantificação dos capilares. Na MET encontraram-se evidências de formação de novos capilares. Conclusões: a PGE1, administrada por via IM ou EV, promoveu, após 14 dias de observação, um aumento no número de capilares no músculo esquelético de ratos submetido à isquemia, identificáveis histologicamente com a coloração em HE. Na análise ultra-estrutural encontraram-se alterações que sugerem, nos animais sob a ação da PGE1, que a neoformação vascular possa ter ocorrido por angiogênese e vasculogênese. A imuno-coloração, apesar da marcação de capilares e vasos maiores, não permitiu estabelecer uma correlação com o aumento de vasos encontrados na coloração com HE.

[Bullet and shrapnel injuries in the face and neck regions. Current aspects of wound ballistics]

A basic understanding of the ballistic behaviour of projectiles or fragments after entering the human body is essential for the head and neck surgeon in the military environment in order to anticipate the diagnostic and therapeutic consequences of this type of injury. Although a large number of factors influence the missile in flight and after penetration of the body, the most important factor is the amount of energy transmitted to the tissue. Long guns (rifles or shotguns) have a much higher muzzle energy compared to handguns, explaining why the remote effects beyond the bullet track play a major role. While most full metal jacket bullets release their energy after 12-20 cm (depending on the calibre), soft point bullets release their energy immediately after entry into the human body. This results in a major difference in extremity wounds, but not so much in injuries with long bullet paths (e.g. diagonal shots). Shrapnel wounds are usually produced with similarly high kinetic energy to those caused by hand- and long guns. However, fragments tend to dissipate the entire amount of energy within the body, which increases the degree of tissue disruption. Of all relevant injuries in the head and neck region, soft tissue injuries make up the largest proportion (60%), while injuries to the face are seen three times more often than injuries to the neck. Concomitant intracranial or spinal injury is seen in 30% of cases. Due to high levels of wound contamination, the infection rate is approximately 15%, often associated with a complicated and/or multiresistant spectrum of germs.

The subcostal artery perforator flap; an anatomical study

BACKGROUND: Based on a previous clinical case report in which the pedicled subcostal artery perforator flap allowed for the closure of a large defect of the lumbar region, the present study was designed to investigate the anatomy of the subcostal artery perforator flap and to evaluate its potential for wider clinical use. METHODS: A series of 14 human cadavers was studied and 28 subcostal artery perforator flaps were dissected. The location of the perforator vessel was charted against anatomical landmarks. Measurements included the perforator calibre, pedicle length, and flap size following methylene blue injection. The findings were compared by Doppler sonography in 15 volunteers. RESULTS: The subcostal artery perforator was present in all dissected specimens and in all volunteers. Its calibre measured in mean 2mm. The location was constant at the lateral border of the latissimus dorsi muscle and between 1 and 3cm below the lower rib end. The pedicle length reached a mean of 10.5cm when dissected up to the border of the erector spinae musculature. The vascular supply covered a mean flap size of 10x14cm. The in vivo investigations confirmed the constant perforator location from the anatomical landmarks. CONCLUSION: This anatomical study reveals a considerable potential for the clinical use of the subcostal artery perforator flap for defect coverage in the lumbar area, due to its constant and reliable anatomy. Doppler sonography can be helpful in preoperative assessment of the size and the position of the subcostal perforator, thus allowing for an optimal flap design.

Gunshot-related displacement of skin particles and bacteria from the exit region back into the bullet path

In previous studies, it was shown that there is a gunshot-related transport of skin particles and microorganisms from the entrance region into the depth of the bullet path. The present study deals with the question of whether gunshots may also cause a retrograde transport of skin particles and microorganisms from the bullet exit region back into the bullet path. For this purpose, we used a composite model consisting of rectangular gelatin blocks and pig skin. The skin pieces were firmly attached to the gelatin blocks on the side where the bullet was to exit. Prior to the test shots, the outer surface of the pig skin was contaminated with a thin layer of a defined bacterial suspension. After drying the skin, test shots were fired from a distance of 10 m using cartridges calibre .38 spec. with different bullet types. Subsequent analyses showed that in all shots with full penetration of the composite model, the bullet path contained displaced skin particles and microorganisms from the skin surface at the exit site. These could be regularly detected in the distal 6-8 cm of the track, occasionally up to a distance of 18 cm from the exit hole. The distribution of skin particles and microorganisms is presented and the possible mechanism of this retrograde transport is discussed.

Transapical access closure: the TA PLUG device

OBJECTIVES Percutaneous closure of the transapical (TA) access site for large-calibre devices is an unsolved issue. We report the first experimental data on the TA PLUG device for true-percutaneous closure following large apical access for transcatheter aortic valve implantation. METHODS The TA PLUG, a self-sealing full-core closure device, was implanted in an acute animal study in six pigs (60.2 ± 0.7 kg). All the pigs received 100 IU/kg of heparin. The targeted activated clotting time was left to normalize spontaneously. After accessing the left ventricular apex with a 39 French introducer, the closure plug device was delivered with a 33 French over-the-wire system under fluoroscopic guidance into the apex. Time to full haemostasis as well as rate of bleeding was recorded. Self-anchoring properties were assessed by haemodynamic push stress under adrenalin challenge. An additional feasibility study was conducted in four pigs (58.4 ± 1.1 kg) with full surgical exposure of the apex, and assessed device anchoring by pull-force measurements with 0.5 Newton (N) increments. All the animals were electively sacrified. Post-mortem analysis of the heart was performed and the renal embolic index assessed. RESULTS Of six apical closure devices, five were correctly inserted and fully deployed at the first attempt. One became blocked in the delivery system and was placed successfully at the second attempt. In all the animals, complete haemostasis was immediate and no leak was recorded during the 5-h observation period. Neither leak nor any device dislodgement was observed under haemodynamic push stress with repeated left ventricular peak pressure of up to 220 mmHg. In the feasibility study assessing pull-stressing, device migration occurred at a force of 3.3 ± 0.5 N corresponding to 247.5 mmHg. Post-mortem analyses confirmed full expansion of all devices at the intended target. No macroscopic damage was identified at the surrounding myocardium. The renal embolic index was zero. CONCLUSIONS True-percutaneous left ventricular apex closure following large access is feasible with the self-sealing TA PLUG. The device allows for immediate haemostasis and a reliable anchoring in the acute animal setting. This is the first report of a true-percutaneous closure for large-calibre transcatheter aortic valve implantation access.

Fluktuierende Kopfschmerzen und Wesensveränderung bei einem 63-jährigen Patienten

We present a 63 year old man with new onset of fluctuating headache and behavioural changes showing marked inhibition and disorientation. After non invasive and invasive diagnostics an isolated cerebral vasculitis was found. Key results have been found in cerebral MRI and cerebral digital subtraction angiography with irregularities of vessel calibre of the intracerebral arteries. During treatment with high-dose corticosteroid therapy and Cyclophosphamid pulse therapy qualitative disorders and headache rapidly regressed. We discuss differential diagnosis of secondary headache, etiology of cerebral vasculitides, diagnostic challenge and therapy in isolated cerebral vasculitis.

Low serum testosterone and increased diastolic ocular perfusion pressure: a risk for retinal microvasculature

BACKGROUND Low levels of testosterone in men and changes in retinal microvascular calibre are both associated with hypertension and cardiovascular disease risk. Sex hormones are also associated with blood flow in microvascular beds which might be a key intermediate mechanism in the development of hypertension. Whether a direct association between endogenous testosterone and retinal microvascular calibre exists is currently unknown. We aimed to determine whether testosterone is independently associated with ocular perfusion via a possible association with retinal vascular calibre or whether it plays only a secondary role via its effect on blood pressure in a bi-ethnic male cohort. PROBANDS AND METHODS A total of 72 black and 81 white men (28-68 years of age) from the follow-up phase of the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study were included in this sub-study. Ambulatory pulse pressure and intraocular perfusion pressures were obtained, while metabolic variables and testosterone were measured from fasting venous blood samples. Retinal vascular calibre was quantified from digital photographs using standardised protocols. RESULTS The black men revealed a poorer cardiometabolic profile and higher pulsatile pressure (>50 mm Hg), intraocular pressure and diastolic ocular perfusion pressure than the white men (p≤0.05). Only in the white men was free testosterone positively associated with retinal calibre, i.e. arterio-venular ratio and central retinal arterial calibre and inversely with central retinal venular calibre. These associations were not found in the black men, independent of whether pulse pressure and ocular perfusion pressure were part of the model. CONCLUSIONS These results suggest an independent, protective effect of testosterone on the retinal vasculature where an apparent vasodilatory response in the retinal resistance microvessels was observed in white men.

Poscosecha de ciruela variedad angeleno : conservación frigorífica tradicional y en atmósfera modificada

Objetivos: reducir pérdidas durante la conservación frigorífica, emplear atmósfera modificada como método suplementario a la refrigeración, alargar el período de aptitud comercial. Metodología: se trabajó con fruta acondicionada a 0±1 °C y 90±5 % HR, según las siguientes variantes: 1. testigo: 20 kg fruta a granel sin seleccionar en caja plástica; 2. granel + film PVC: 10 kg de fruta a granel en bandejas de madera más cartón corrugado recubierta con film de PVC; 3. celpack: bandejas de madera recubiertas de cartón corrugado con dos celpack de 23 frutos cada uno; 4. celpack + atmósfera modificada: ídem anterior pero cada celpack en bolsa de polietileno de baja densidad de 20 μ. A partir de los 30 días de conservación se extrajo semanalmente, durante 9 semanas, una muestra de 46 frutos, de los cuales 23 fueron analizados al momento de ser extraídos y los 23 restantes luego de 48 horas de comercialización simulada (sc). Para la evaluación estadística se aplicó análisis de la varianza con el programa SAS (Statistical Analysis System) y se determinaron las diferencias entre tratamientos con el test de Duncan. Para sabor, en cambio, se aplicó una prueba de homogeneidad de P2. La evaluación de sabor se realizó mediante degustación con panel de 5 catadores entrenados. Resultados: Los frutos tenían las siguientes características al inicio de conservación: calibre 61.4 mm, peso 117.8 g, firmeza de pulpa 3.1 kgf, sabor agridulce, contenido de sólidos solubles 17.5 °Bx, acidez 0.78 g ác. málico%g, % cubrimiento 83.69 %. Luego de la conservación frigorífica (97días): % de color de cobertura 95 %. La firmeza de la pulpa en el tratamiento celpack + bolsa se diferencia con valores más altos, media de 2.8 kgf , el resto con media 2.6 kgf. En sc la firmeza es inferior y esta disminución es menor en celpack + bolsa. Sólidos solubles, media 17.21 °Bx, en sc valores con media de un 0.3 % más. Acidez titulable: disminución progresiva, de 0.68 a 0.47 g%g al fin de conservación. Sabor: a partir de los 59 días aumentan los frutos insípidos y desagradables excepto en celpack + bolsa. Síntomas de deshidratación: a partir de los 79 días la única variante que no presenta síntomas es celpack + bolsa. Conclusiones: El acondicionamiento en celpack redujo la incidencia de ataque por mohos (fue el único tratamiento sin ataque durante 94 días); tampoco presentó sabores desagradables y su limitación en conservación se debió a la deshidratación evidente a partir de 74 días. La fruta embalada en celpack + bolsa tuvo mayores valores de resistencia a la presión y 100 % de frutos sin deshidratación a los 94 días de conservación; a partir de 80 días es evidente el ataque de mohos y frutos con sabores desagradables. Las variantes granel y granel + film presentan deterioro por deshidratación a partir de 74 días. La conservación no debería superar 80 días. Celpack + bolsa muestra mejores resultados, con mayores valores de resistencia a la presión que los otros tratamientos; con respecto al sabor, mantiene una mayor proporción de sabor dulce.

Asociaciones entre clones y anormalidades morfológicas en ajo

Con el objeto de detectar la influencia del genotipo en la presencia de anormalidades morfológicas, se tomó una muestra de 200 bulbillos de cada uno de los 7 clones de ajo colorado, incluidos en un ensayo experimental en bloques completamente aleatorizados con 4 repeticiones, en un solo ambiente de expresión. En cada clon se computaron las proporciones de bulbos normales, pera, cebollón y doble. En los bulbos normales se midió la distribución de calibres. Se compararon las proporciones de anormalidades entre los clones. Un clon se diferenció (p < 0,05) de los restantes por no poseer malformaciones y presentar un calibre promedio bajo. Utilizando en conjunto la información obtenida, se realizó un análisis de componentes principales y de conglomerado. Se utilizó la distancia euclidiana promedio y el método de ligamiento promedio. Los dos primeros ejes del análisis de componentes principales representaron el 74% de la variación de los datos. La información obtenida permitió reunir 3 grupos de clones por su asociación a calibres y anormalidades morfológicas. El primer grupo formado por un clon sin anormalidades y con mayor proporción de calibre 4 y 5; el segundo, de cuatro clones con presencia de ajo cebollón y el tercero, de dos clones asociados a los bulbos pera, dobles y de calibres 6. Se demostró la influencia del genotipo en la frecuencia de anormalidades morfológicas.

Determinación de reducción del crecimiento radical (CE50) por una formulación de glifosato utilizando lechuga y trigo como especies bioindicadoras

El objetivo fue determinar la concentración efectiva media de reducción del crecimiento radical (CE50), de una formulación del herbicida glifosato mediante bioensayos de germinación con semillas de lechuga y de trigo. Para lechuga se probaron 9 dosis/tratamientos decrecientes entre 1.215 y 0,01215 g i.a.ha-1 (formulado: Sal amónica de la N-Fosfonometil glicina, 40,5 [g e.a. glifosato 36,9% p/v]) y para trigo 5 dosis decrecientes (entre 12,15 y 1,215 g i.a.ha-1) y su respectivo control negativo (agua destilada). Se utilizaron cajas de Petri, con papel de filtro en la base humedecido con 3 ml de la solución correspondiente. Se sembraron 20 semillas por caja, distribuyéndose los tratamientos en bloques al azar con 4 repeticiones, en cámara de crecimiento a 20°C con alternancia de luz y oscuridad. Se midió la longitud radicular de todas las semillas de cada tratamiento con calibre digital. Se determinó el porcentaje de germinación y se calculó el índice de germinación. Las CE50, es decir, las dosis que redujeron en un 50% el crecimiento radical para lechuga y trigo, fueron 6,682 y 9,416 g i.a.ha-1, respectivamente. Los materiales probados resultaron sensibles a distintas dosis de glifosato y por lo tanto pueden utilizarse como indicadores biológicos de toxicidad específica.