A total laparoscopic technique for endovascular thoracic stent graft deployment

Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.)

Tratamento de linfocele inguinal pós-operatória com injeção de cola de fibrina: relato de caso

O paciente desenvolveu linforragia na região inguinal direita, depois de ponte aorto-bifemoral com enxerto de dácron®. Não respondeu ao tratamento conservador com cuidados locais e compressão. Foi realizado exame de ultra-sonografia Doppler, que evidenciou grande linfocele (6,4 x 3,36 x 6,1 cm), tratada pelo esvaziamento da loja por aspiração e injeção de cola de fibrina (1,6 mL) em seu interior. O paciente se recuperou sem intercorrências e sem recidiva, após 3 meses de seguimento.

Urethral reconstruction after total penectomy for urethral cancer

A 59-year-old white man developed a ventral ulcer with irregular limits in the middle portion of the penis. The result of the pathologic analysis was compatible with invasive squamous cell urethral carcinoma. A total penectomy was performed. In these cases, the usually recommended urinary diversion is perineal urethrostomy. However, due to the specifications of the case, perineal urethrostomy could not be performed. The literature did not offer any other alternative for patients with this same condition. Therefore, a urethral reconstruction using a groin skin flap had to be performed. Copyright (C) 2004 S. Karger AG, Basel.

A new species of the Dendropsophus parviceps group from the western Amazon Basin (Amphibia: Anura: Hylidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ischemia and reperfusion in skin flaps: effects of mannitol and vitamin C in reducing necrosis area in a rat experimental model

OBJETIVO: Neste trabalho foi padronizado modelo experimental de isquemia e reperfusão em retalho cutâneo em ratos no qual estudou-se possibilidade de uma solução antioxidante, composta por Ringer lactato, vitamina C e manitol de reduzir a área de necrose. MÉTODOS: O modelo consistiu de levantamento de retalho cutâneo axial de 6,0 x 3,0cm, submetido à isquemia de 8 horas e reperfusão de 7 dias. Os animais foram divididos em quatro grupos: grupos S1, S2 (10 animais cada), C e T (14 animais cada). Nos grupos S1 e S2 todos os procedimentos dos demais grupos foram efetuados, exceto a isquemia e reperfusão: S1 recebeu apenas Ringer lactato e S2 a solução antioxidante. Os grupos C e T foram submetidos à isquemia. O grupo C recebeu somente Ringer lactato e o grupo T a solução antioxidante. No 7(0) dia de pós-operatório as áreas de necrose e pele viável do retalho foram delineadas em decalque de acetato, os quais foram por sua vez analisados em sistema computadorizado KS-300 (Carl Zeiss). RESULTADOS: A análise estatística mostrou que não houve diferenças significativas entre o grupo tratado e controle quanto à área de necrose. CONCLUSÃO: Concluiu-se que o modelo experimental é consistente, determinando área de necrose limitada e uniforme nos animais não tratados e que as drogas usadas, nessa posologia e modo de aplicação, não foram efetivas em diminuir a área de necrose no modelo experimental em questão.

Scent-marking behaviour in free-ranging golden-faced saki monkeys, Pithecia pithecia chrysocephala: Sex differences and context

Scent-marking behaviour of golden-faced saki monkey, Pithecia pithecia chrysocephala, was observed intermittently between 1987 and 1990 for a family group in a Central Amazonian forest fragment. of 95 scent-marking events (during 275.5 hours of observation), throat-and-chest rubbing accounted for all except one anogenital rubbing. Nine of the throat-and-chest markings also involved touching groin with hands and eight markings (including the anogenital), urinating on the marked branch. Marking behaviour is strongly sex related, with the adult male making 88.4% of the markings. Scent-marking frequency by the adult male increased during breeding periods. Scent-marking behaviour seems related to courtship, and possibly stimulates sexual behaviour. All regularly marked spots consisted of horizontal branches on commonly travelled routes. Eleven occurred in feeding trees and lianas, but none in sleeping trees. Scent-marking behaviour in the monkeys studied here was not related to intergroup encounters and probably did not have a territorial function, although it may do so where different groups interact.

Mesh cancer: long-term mesh infection leading to squamous-cell carcinoma of the abdominal wall

Purpose: It is recognized that chronic inflammation can cause cancer. Even though most of the available synthetic meshes are considered non-carcinogenic, the inflammatory response to an infected mesh plays a constant aggression to the skin. Chronic mesh infection is frequently the result of misuse of mesh, and due to the challenging nature of this condition, patients usually suffer for years until the infected mesh is removed by surgical excision. Methods: We report two cases of squamous-cell carcinoma (SCC) of the abdominal wall, arising in patients with long-term mesh infection. Results: In both patients, the degeneration of mesh infection into SCC was presumably caused by the long-term inflammation secondary to infection. Patients presented with advanced SCC behaving just like the Marjolin's ulcers of burns. Radical surgical excision was the treatment of choice. The involvement of the bowel played an additional challenge in case 1, but it was possible to resect the tumor and the involved bowel and reconstruct the abdominal wall using polypropylene mesh as onlay reinforcement, in a single stage operation. He is now under adjuvant chemotherapy. The big gap in the midline after tumor resection in case 2 required mesh bridging to close the defect. The poor prognosis of case 2 who died months after the operation, and the involvement of the armpit, groin and mesenteric nodes in case 1 shows how aggressive this disease can be. Conclusion: Infected mesh must be treated early, by complete excision of the mesh. Long-standing mesh infection can degenerate into aggressive squamous-cell carcinoma of the skin. © 2013 Springer-Verlag France.

Description and phylogenetic relationships of a new species of treefrog of the Dendropsophus leucophyllatus group (Anura: Hylidae) from the Amazon basin of Colombia and with an exceptional color pattern

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Exploração de fatores de risco na natação

Pós-graduação em Fisioterapia - FCT

Pênfigo Foliáceo em cães

Pemphigus complex in animals is considered rare, but not so when compared with the occurrence of other autoimmune diseases. Pemphigus Foliaceus in dogs is the most common varieties of pemphigus and is characterized clinically by intraepidermal pustules, starting on the face and ears, pads, groin, and may become multifocal or generalized in six months. As the pustules are very fragile, the lesions usually found are secondary, which may range from dry to collarettes epidermal crusting, and nasal depigmentation. The diagnosis is difficult because presents sintomatology similar to other diseases and laboratory diagnosis more precise through the histopathological examination of pustules integrate (biopsy), which are rarely found. The treatment, although of the individual treatment regimen, is based on treating opportunistic diseases and immunosuppressing the animal in order to decrease the production of autoantibodies. The drugs of choice depend on the clinical presentation, however is usually oral prednisone and azathioprine in the dog and combined immunosuppressive therapy. Should make use daily until the disease is inactive and gradually decrease the dose until have the minimum effective dose, preferably on alternate days for the remission of the disease. Prognosis of pemphigus varies according to disease stage and treatment established. Pemphigus foliaceus is less serious nonetheless might be fatal without treatment

A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45º, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45º view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45º, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45º, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.

Prevalence and impact of pain at the greater trochanter after open surgery for the treatment of femoro-acetabular impingement

Femoro-acetabular impingement can cause pain and degenerative changes of the hip joint. Traditionally, surgical dislocation of the hip joint has been performed for correction of pathologic abnormalities in the proximal part of the femur and the acetabulum. Failures of surgical treatment are often related to postoperative pain in the groin or in the area of the greater trochanter, associated with this surgical approach. The aim of our study was to determine the prevalence and functional impact of pain at the greater trochanter after surgical dislocation of the hip.

Prospective randomized trial comparing sutured with sutureless mesh fixation for Lichtenstein hernia repair: long-term results

Following Lichtenstein hernia repair, up to 25% of patients experience prolonged postoperative and chronic pain as well as discomfort in the groin. One of the underlying causes of these complaints are the compression or irritation of nerves by the sutures used to fixate the mesh. We compared the level and rate of chronic pain in patients operated with the classical Lichtenstein technique fixated by sutures to patients with sutureless mesh fixation technique.

Femoroacetabular impingement

Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions. Pincer impingement generally involves the acetabular side of the joint where there is excessive coverage of the acetabulum, which may be focal or more diffuse. There is linear contact of the acetabulum with the head/neck junction. Cam impingement involves the femoral head side of the joint where the head is associated with bony excrescences and is aspheric. The aspheric femoral head jams into the acetabulum. Imaging appearances are reviewed below. This type is evident in young males in the second and third decades. The main features of FAI are described.

Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection

BACKGROUND: Ilioinguinal and iliohypogastric nerve blocks may be used in the diagnosis of chronic groin pain or for analgesia for hernia repair. This study describes a new ultrasound-guided approach to these nerves and determines its accuracy using anatomical dissection control. METHODS: After having tested the new method in a pilot cadaver, 10 additional embalmed cadavers were used to perform 37 ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve. After injection of 0.1 ml of dye the cadavers were dissected to evaluate needle position and colouring of the nerves. RESULTS: Thirty-three of the thirty-seven needle tips were located at the exact target point, in or directly at the ilioinguinal or iliohypogastric nerve. In all these cases the targeted nerve was coloured entirely. In two of the remaining four cases parts of the nerves were coloured. This corresponds to a simulated block success rate of 95%. In contrast to the standard 'blind' techniques of inguinal nerve blocks we visualized and targeted the nerves 5 cm cranial and posterior to the anterior superior iliac spine. The median diameters of the nerves measured by ultrasound were: ilioinguinal 3.0x1.6 mm, and iliohypogastric 2.9x1.6 mm. The median distance of the ilioinguinal nerve to the iliac bone was 6.0 mm and the distance between the two nerves was 10.4 mm. CONCLUSIONS: The anatomical dissections confirmed that our new ultrasound-guided approach to the ilioinguinal and iliohypogastric nerve is accurate. Ultrasound could become an attractive alternative to the 'blind' standard techniques of ilioinguinal and iliohypogastric nerve block in pain medicine and anaesthetic practice.