Use of an Inflatable Silicone Balloon Improves the Success Rate of Bladder Autoaugmentation at Long-Term Followup

Purpose: Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed (R) silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results. Materials and Methods: We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics. Results: In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean +/- SD compliance increased from 15.6 +/- 16.8 to 34.3 +/- 22.8 ml/cm H(2)O (p = 0.02). Conclusions: The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.

Endoscopic treatment of Zenker`s diyerticulum by harmonic scalpel

Background: Zenker`s diverticulum (ZD) is a rare condition with a reported prevalence of 0.01% to 0.11% in the general population. Endoscopic treatment consists of the division of the septum between the diverticulum and the esophagus, within which the cricopharyngeal muscle is contained. Diathermic monopolar current, argon plasma coagulation, and laser have been used to incise the muscular septum with satisfactory results. The main limitation of endoscopic treatment is the occurrence of complications. Perforation and hemorrhage are reported in as many as 23% and 10% of patients, respectively. Objective: The aim of this study was to use the technique of endoscopic diverticulotomy by using a harmonic scalpel in patients with ZD and to demonstrate the feasibility of using flexible and rigid devices in ZD treatment. Design: Case series study. Standard protocol was used for patient management, endoscopic procedure, and data collection. Setting: Single endoscopist demonstrating preliminary results. Patients: Five patients (4 men; median standard deviation [SD] age 69.6 +/- 9.06 years, range 59-83 years) with ZD were treated with this technique. All patients reported dysphagia and halitosis. The diagnosis was based on clinical, endoscopic, and radiographic findings. Interventions: All patients received general anesthesia and were placed in the left lateral position. A standard videogastroscope (9.8 mm) and a stiff guidewire were used to insert and achieve an adequate exposure of the ZD septum. The septum was divided using a harmonic scalpel under thin endoscope (5.2 mm) visualization through a soft diverticuloscope. Main Outcome Measurement: Feasibility of an endoscopic technique by using rigid and flexible devices to treat ZD. Results: Four patients (80%) were successfully treated in 1 session. The median SD size of the diverticulum was 3.6 +/- 0.89 cm (range 3-5 cm). Median SD procedure time was 17.33 +/- 2.33 minutes (range 15-20 minutes) in 6 procedures. No hemorrhage or perforation occurred. One patient (20%) required a second session to complete dissection of the ZD septum. All patients demonstrated improvement of dysphagia score after treatment. Limitations: Small case series design. Conclusions: Endoscopic treatment of ZD by harmonic scalpel through a soft diverticuloscope was feasible and effective in this small case series. Larger studies are warranted to further evaluate this technique.

Tubular eyes of deep-sea fishes: A comparative study of retinal topography

The world's deep oceans are home to a number of teleosts with asymmetrical or tubular eyes. These immobile eyes possess large spherical lenses and subtend a large binocular visual field directed either dorsally or rostrally. Derived from a lateral non-tubular eye, the tubular eye is comprised of a thick main retina, subserving the rostrally or dorsally directed binocular visual field, and a thin accessory retina subserving, the lateral, monocular visual field. The main retina is thought to receive a focussed image, while the accessory retina is too close to the lens for a focussed image to be received. Several species also possess retinal diverticula, which are small evaginations of differentiated retina located in the rostrolateral wall of the eye and thought to increase the visual field. In order to investigate the spatial resolving power of these retinae (main, accessory and diverticulum), the distribution of cells within the ganglion cell layer was analysed from retinal wholemounts and sectioned material in ten species representing four genera. In all species, the main retina possesses a marked increase in cell density towards a specialised retinal region (area centralis), with a centro-peripheral gradient range between 7.1 and 60:1 and a peak density range of between 30 and 55 x 10(3) cells per mm(2). The accessory retinae and the transitional zone between the main and accessory retinae possess relatively low cell densities (between 1 and 10 x 10(3) cells per mm(2)) and lack an area centralis. Retinal diverticula examined in four species possess mean ganglion cell densities of between 7.2 and 109.4 x 10(3) cells per mm(2). Analyses of soma areas show that the ganglion cell layer of most species possesses cells with areas in a range of 8.0 to 15.4 mu m(2) in the main retina and between 15.1 and 17.4 mu m(2) in the accessory retina. The peak spatial resolving power of the main retina of the ten species varies from 4.1 to 9.1 cycles per degree. The positions of the retinal areae centrales relative to each species' binocular visual field are discussed in relation to what is known of feeding behaviour of these fishes in the deep-sea.

Avaliação da dose absorvida na tiróide, em cintigrafias com 123I e Na99mTcO4 utilizando modelos biocinéticos e métodos de Monte Carlo

Mestrado em Radiações Aplicadas às Tecnologias da Saúde. Área de especialização: Protecção contra Radiações

Divertículos da uretra feminina: uma revisão contemporânea

Introduc¸ão: Os divertículos uretrais femininos (DUF) afetam de 0,6 a 4,7% das mulheres, causam frequentemente sintomas urinários persistentes e podem associar-se a complicac¸ões como litíase e transformac¸ão maligna. Existe ainda elevado subdiagnóstico de DUF, bem como atraso diagnóstico e terapêutico. O objetivo deste trabalho é analisar o estado de arte em relac¸ão à etiologia, diagnóstico e terapêutica desta patologia. Materiais e métodos: Revisão bibliográfica de artigos obtidos até janeiro/2014 na base de dados Medline utilizando as palavras-chave: «female urethral diverticula», «female urethral diverticulum», «urethral diverticula», «urethral diverticulum» e «female urethra»; e após pesquisa de referências bibliográficas relevantes nos artigos obtidos. Resultados: A maioria dos DUF parecem surgir secundariamente à infec¸ão das glândulas periuretrais e uretrais. Apesar da associac¸ão clássica à tríade de disúria, dispareunia e gotejo pós-miccional, as manifestac¸ões clínicas são diversas e inespecíficas. Mais de um terc¸o são palpáveis ao exame ginecológico. Os métodos imagiológicos disponíveis, nomeadamente a ressonância magnética e a ecografia, apresentam elevada capacidade diagnóstica e contribuem para o planeamento cirúrgico. Dependendo da localizac¸ão, conformac¸ão e sintomatologia associada, a terapêutica dos DUF poderá ser conservadora ou, na maioria dos casos, cirúrgica. Discussão: A avaliac¸ão clínica permanece essencial para o diagnóstico de DUF. A ressonância magnética é a modalidade com maior taxa de diagnóstico e de exclusão de complicac¸ões pré ou pós-operatórias. Foram descritas técnicas menos invasivas, porém a diverticulectomia uretral transvaginal permanece a terapêutica com maior cura sintomática. Conclusão: A sensibilizac¸ão da comunidade médica é a melhor arma no combate ao subdiagnóstico e atraso diagnóstico dos DUF.

Morfología del aparato digestivo de Enteroctopus megalocyathus y Loligo sanpaulensis (Mollusca, Cephalopoda)

A detailed description of the morphology of the digestive organs of Enteroctopus megalocyathus (Gould, 1852) and Loligo sanpaulensis Brakoniecki, 1984 is given. The mandibles, the crop diverticulum, a doubly coiled caecum, the loop of the medium intestine and the appendages of the digestive gland are first described for E. megalocyathus. The most outstanding finding in L. sanpaulensis is the location of the single posterior salivary gland, wholly embedded in the digestive gland.

Observation on the morphology of Australorbis glabratus

The present morphological study of A. glabratus was based on the observation of shell, radula, renal region and genitalia of 50 specimens having a shell diameter of 18 mm. In this summary we record the data pertaining to the chracteristics that can be used in systematics. The numerals refere to the mean and their standard deviation; no special reference being made, they correspond to length measurements. Shell: 18 mm in diameter, 5.59 ± 0.24 mm in greatest width, 5 to 6 whorls. Right side umbilicated, left one weakly depressed. Last whorl about thrice as tall as the penultimate one at the aperture, the measurements being taken on the right side. Aperture perpendicular or a little oblique. Body, extended: 47.06 ± 3.31 mm. Renal tube: Narrow and elongated, 23.84 ± 1.90 mm, showing a pigmented ridge along its ventral surface. Ovotestis: 12.78 ± 1.50 mm. Mainly trifurcate diverticula attaching in fan-like manner to the collecting canal (this arrangement is seen to best advantage in the cephalic middle of the ovotestis). The collecting canal greatly swells at the cephalic end, narrowing suddenly as it leaves the ovotestis. Ovisperm duct: 13.70 ± 1.68 mm, including the non-unwound seminal vesicle. The latter, situated about 1 mm from the beginning af the ovisperm duct, was 1.14 ± 0.29 mm in greatest diameter, and is beset by numerous short diverticula. Sperm duct: 14.16 ± 1.27 mm, pursuing a sinous course along the oviduct. Prostate: Prostate duct 5.53 ± 0.74 mm, collecting a row of long diverticula, the latter 21.6 ± 3.5 in number. Last diverticulum generally simple or bifurcate, penultimate generally arborescent, bifurcate or simple, antepenultimate nearly always arborescent, the remaining ones arborescent. The arborescent diverticula frequently give off secondary branches. Vas deferens: 17.50 ± 2.05 mm. The ratio vas deferens/vergic sac was 4.7 ± 0.6. Verge: 3.70 ± 0.54 mm long, 0.12 ± 0.03 mm wide. Free end tapering to a point where the sperm canal opens. No penial stylet. Vergic sac: 3.77 ± 0.50 mm long, 0.19 ± 0.01 mm wide. The length ratio vergic sac/preputium was 1 ± 0.02. Preputium: Deeply pigmented, 3.79 ± 0.40 mm long, 0.89 ± 0.12 mm wide in the middle. Muscular diaphragm between it and the vergic sac. Two muscular pilasters along its lateral walls. Oviduct: 10.24 ± 1.29 mm, suddenly swollen at the cephalic end so that it forms a folded pouch capping the beginning of the uterus. Uterus: 10.58 ± 1.18 mm. Vagina: 2.06 ± 0.15 mm long, 0.32 ± 0.05 mm wide, showing a swelling at its caudal portion, just above the opening of the spermathecal duct. Spermatheca: 1.57 ± 0.41 mm long, 0.92 ± 0.23 mm wide. Spermathecal duct 1.15 ± 0.23 mm. Radula: 125 to 163 rows of teeth (mean 141.4 ± 9.8). Radula formula 27-1-27 to 34-1-34 (mean 30.9 ± 1.7).

Observations on the morphology of Australorbis nigricans

A morphological study was done on A. nigricans, based on the observation of shell, radula, renal region and genitalia of 50 specimens measuring 18 mm in diameter. The data obtained are to be compared with those recorded in our previous paper (PARAENSE & DESLANDES, 1955) on A. glabratus. The characteristics common to both species will not be mentioned here. The numerals refere to the means and their standard deviations: no special reference being done, they correspond to length measurementes. Shell - 18 mm in diameter, 6.37 ± 0.29 mm in greatest width, 6 whorls. Prevailing colur ferruginous sepia, a minority of olivaceous, ochreous, nigrescent and deeply black specimens being found. Right side variously depressed, umbilicated, 1.5 to 3.5 mm deep from the bottom of the umblicus to the highest level of the last whorl. Left side more depressed than the right one, broadly concave, 1.5 to 3.5 mm deep. Both sides show a varously distinct keel, that looks sharper at the left. Aperture deltoid, varying in outline and width. Body, extended - 60.26 ± 3.62 mm, less pigmented than in glabratus. Renal tube - 30.68 ± 1.69 mm, showing neither ridge nor pigmented line along its ventral surface, this negative character affording a sure means of separation from glabratus. Ovotestis - 14.48 ± 1.93 mm. Ovisperm duct - 13.04 ± 1.60 mm, including the non-unwound seminal vesicle. The latter was 0.97 ± 0,21 mm in greatest width. Carrefour - Resembling that of glabratus. Sperm duct - 21.36 ± 1.53 mm. Prostate - Prostate duct 7.14 ± 0.74 mm, collecting a row of long diverticula numbering 19.6 ± 3.1 and more separate than in glabratus. Last diverticulum generally bifurcate or arborescent, the remaining ones arborescent. Vas deferens - 28.68 ± 1.38. Ratio vas deferens/vergic sac = 6.8±0.8. Verge - 3.08 ± 0.28 mm long, 0.11 ± 0.02 mm wide. Vergic sac - 3.07 ± 0.28 mm long, about 0.20 mm wide. Ratio vergic sac/preputium = 0.84 ± 0.12. Preputium - 3.69 ± 0.47 mm long, 0.85 ± 0.10 mm wide. Albumen gland - Resembling taht of glabratus. Oviduct - 16.26 ± 1.41 mm, swollen at the cephalic end. Uterus - 13.24 ± 1.19 mm. Vagina - 1.70 ± 0.22 mm, swolen at the caudal portion. Spermatheca - 2.78 ± 0.40 mm long, 0.86 ± 0.16 mm wide. Spermathecal duct 1.11 ± 0.20 mm. Radula - 125 to 168 horizontal rows of teeth (mean 153.9 ± 8.4). Radula formula 28-1-28 to 36-1-36 (mean 31.8 ± 1.9). Mode formula 31-1-31. The morphological characteristics of the renal region and shell, and the great body length in the same condition of shell diameter, distinguish A. nigricans from the most related species A. glabratus, giving support to considering it a good species from a txonomic or phenotypic standpoint (morphospecies).

Biomphalaria obstructa (Morelet, 1849): a study of topotypic specimens (Mollusca: pulmonata: planorbidae)

A description of Biomphalaria obstructa (Morelet, 1849), based on specimens collected at its type locality - isla del carmen, state of Campeche, Mexico - is presented. The Shell is small, 13 mm in diameter, 3.5 mm in width and with 5.75 whorls in the largest specimen, thin, moderately lustrous and translucent, horn-colored. Whorls increasing regularly (neither slowly nor rapidly) in diameter, rounded on the periphery side, bluntly angular on the left. Suture well-marked, deeper on the left. Right side widely concave, with first whorl deeply situated and partly hidden by the next. Left side shallower than right one, largely flattened, with first whorl plaintly visible. Aperture roundly heart-shaped, usually in the same plane as the body whorl but somewhat deflected to the left (less frequently to the right) in some specimens. Peristome sharp, seldom blunt; a distinct callus on the parietal wall. A number of young shells develop one set (seldom more) of apertural lamellae which tend to be resorbed as the shell grows. Absence of renal ridge. Ovotestis with about 70 mostly unbrached diverticula. Seminal vesicle beset with well-developed knoblike to fingerlike diverticula. Vaginal pouch more or less developed. Spermatheca club-shaped when empty, egg-shaped when full, and with intermediate forms between those extremes. Spermathecal body usually somewhat longer than the duct. Prostate with 7 to 20 (mean 12.06 ± 2.51) usually short diverticula which give off plumpish branches spreading out in a fan shape and overlapping to some extent their immediate neighbors. Foremost prostatic diverticulum nearly always partially or completely inserted between the spermathecal body and the uterine wall. Penial sheath consistently narrower and shorter than the prepuce. Muscular coat of the penis consisting of an inner longitudinal and an outer circular layers. Ratios between organ lengths: caudal to cephalic parts of female duct = 0.55 to 1.37 (mean 0.85 +- 0.17); cephalic parte of female duct to penial complex = 1.36 to 2.81 ((mean 1.90 +- 0.33); penial sheath to prepuce = 042 to 0.96 (mean 0.67 +- 0.13). Comparison with Morelet’s type specimens of Planorbis orbiculus and P. retusus points to the identity of those nominal species with B. obstructa.

Acute ulcerative jejunal diverticulitis: case report of an uncommon entity.

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.

The small species of Belostoma Latreille (Heteroptera, Belostomatidae). III. A revision of oxyurum group, with a new species from Brazil and description of the male of B. noualhieri Montandon

Species of the oxyurum group (sensu Lauck) consist of five extant Neotropical small species, whose lengths range 15.0 to 20.0 mm. The anterior interocular width about 1.5 times the width of an eye and ventral diverticulum of phallus flattened, circular, and large are, in combination, diagnostic. The small species of the oxyurum group were included in the Lauck´s key to the identification of the species groups, without dealing with the species included in it because many of them are very similar in appearance. Therefore here we redescribe and key the Belostoma species of the oxyurum group. Belostoma oxyurum (Dufour) is newly recorded from Brazil (Paraná and Rio Grande do Sul). Holotype and lectotype are designated for B. oxyurum and B. sanctulum Montandon, respectively. The aspect of the prosternal keel, the ratio between the width of the ventral diverticulum of phallus and its length in ventral view, and the aspect of dorsal arms of ventral diverticulum have proven useful for better species delimitation. Based on specimens from Pará State (N. Brazil), Belostoma carajaensis Ribeiro & Estévez, sp. nov. is described and illustrated. This new species differs from B. sanctulum in having anteoculus shorter than interoculus and the dorsal arms of ventral diverticulum divergent and large. A male specimen of B. noualhieri Montandon was collected in São Paulo State and based mainly on features of male genitalia, this species is here also included under oxyurum group.

Bilateral Killian-Jamieson diverticula demonstrated by videofluoroscopic swallowing study: case report

The authors report the case of a 56-year-old male patient complaining of dysphagia for solids and food impaction, submitted to videofluoroscopic swallowing study that demonstrated the presence of two esophageal diverticula. The videofluoroscopic swallowing study was critical in the identification and diagnosis of the diverticula, an esophageal cause of dysphagia.

Diverticulo epifrênico do esôfago

Disphagia is a very common complaint among patients seeking a gastroenterologists. Esophageal motility disorder is a frequent finding, at times associated with pulsion diverticula. We present a case of a 68 year old female patient with thoracic pain and double epiphrenic diverticula. The upper gastrointestinal tract examination revealed two epiphrenic diverticula, one with 6-7 cm and the other measuring 2 cm, located 30 cm from the dental arcade. She underwent surgical treatment to remove the larger diverticula, a long esophageal myotomy and a Belsey-Mark IV antireflux technique. She presented an uneventful recovery and is doing well I8 months following surgery.

Divertículo de Zenker

The authors show six cases os Zenker's diverticulum diagnosed and treated at Nossa Senhora da Conceição hospital from January 1994 to January 1997. All patients were syntomatics and underwent to myotomy of cricopharyngeal upper muscle with diverticulectomy.

Hérnia de Littré

Littré's hernia is an extremely rare surgical event. It is characterized by the presence of Meckel's diverticulum in the hernial sack. The authors report one case of Littré's hernia in a 42 year-old male who had the diagnosis accomplished in the intraoperative. The diverticulum presented no signs of complications and was treated conservatively , without exeresis.