Successful management of evisceration occurred after exploratory laparotomy for bilateral ovarian micropapillary serous borderline tumors

Micropapillary serous borderline tumor of the ovary is characterized by a more frequent association with extraovarian, especially invasive, implants. The aim of this study was to report the clinicopathological findings of a rare case of micropapillary serous borderline tumor of the ovary since there are less than 100 similar cases in the published literature. Additionally, the successful management of evisceration that complicated the postoperative stay of the patient is analyzed. The incidence of this severe complication is estimated between 0.29-2.3%. There are four main causes: suture tearing through the fascia, knot failure, suture failure, and extrusion of abdominal contents between sutures placed too far apart. At least 50% of the cases are due to technical error with a potentially lethal result.

Gewebeansatz-Strukturen auf pyritisierten Steinkernen von Ammonoideen

3400 pyritized internal moulds of Upper Devonian, Triassic, Jurassic and Lower Cretaceous ammonoids show various soft tissue attachment structures. They are preserved as regularly distributed black patterns on the moulds. All structures can be interpreted as attachment areas of muscles, ligaments and intracameral membranes. Paired structures are developed along the umbilicus and on the flanks of the moulds, unpaired ones appear on the middle of their dorsal and ventral sides. Strong lateral muscles cause paired twin lines on the flanks of the phragmocone and of the body chamber. A ventral muscle is deduced from small rounded or crescent shaped spots in front of each septum on the ventral side. These spots are often connected, forming a band-like structure. Broad dark external bands on the ventral side of the phragmocone, ventral preseptal areas in the posterior part of the living chamber, small twin lines or oval shaped areas on the ventral side of the living chamber represent paired or unpaired attachment areas of the hyponome muscle. A middorsal muscle is documented by small roughened areas in front of each dorsal lobe. Dark spots along the umbilicus, often connected and thus forming a band-like structure (tracking band), are remains of a pair of small dorsolateral muscles at the posterior end of the soft body. Dark bands, lines and rows of small crescent shaped structures behind the tips of sutural lobes are due to spotlike fixation places of the posterior part of the mantle and their translocation before subsequent septal secretion. Devonian goniatites had a paired system of lateral and ventrolateral muscles preserved on the moulds as black or incised lines on the flanks of the living chamber and as dark preseptal areas, ventrally indented. These structures represent the attachment areas of paired lateral cephalic and paired ventral hyponome retractors. Fine black lines on the phragmocone situated parallel to the sutures (pseudosutures) represent a rhythmical secretion of camera! membranes during softbody translocation. Goniatites had a paired system of lateral and ventrolateral muscles, whilst Neoammonoids have a paired lateral and dorsolateral system, and, additionally, an unpaired system on the ventral and on the dorsal side. Mesoammonoids show only a paired lateral and an unpaired dorsal one. Fine black lines situated parallel to the saddles and behind the lobes of the suture line can be interpreted as structures left during softbody translocation and a temporary attachment of rhythmical secreted cameral membranes. Cameral membranes had supported the efficiency of the phragmocone. Only some of the observed structures are also present in recent Nautilus. Differences in the form and position of attachment sites between ammonoids and recent Nautilus indicate different soft body organizations between ammonoids and nautiloids. The attachment structures of goniatites especially of tornoceratids can be compared with those of Nautilus which indicates Richter - Gewebeansatz-Strukturen bei Ammonoideen 3 a comparable mode of life. Differences in the form and position of attachment structures between goniatites and ammonites may indicate an increasing differentiation of the muscular system in the phylogeny of this group. Different soft body organization may depend on shell morphology and on a different mode of life. On the modification or reduction of distinct muscle systems ammonoids can be assigned to different ecotypes. Based on shell morphology and the attachment areas of cephalic and hyponome retractor muscles two groups can be subdivided: - Depressed, evolute morphotypes with longidome body-chambers show only small ventral hyponome retractor muscles. Lateral cephalic retractors are not developed. These morphotypes are adapted to a demersal mode of life. Without strong cephalic retractor muscles no efficient jet propulsion can be produced. These groups represent vertical migrants with efficient phragmocone properties (multilobate sutures, cameral membranes, narrow septal spacing). - Compressed, involute moiphotypes with brevidome body-chambers show strong cephalic and hyponome retractor muscles and represent a group of active swimmers. These morphotypes were able to live at different depths, in the free water column or/and near the seafloor. They are not confined only to one habitat. Most of the examined genera and species belong to this group. Changes of the attachment structures in the course of ontogeny confirm that juveniles of Amaltheus and Quenstedtoceras lived as passive planche drifters in upper and intermediate parts of the free water column after hatching. At the end of the juvenile stage with a shell diameter of 0,3 - 0,5 cm cephalic retractor muscles developed. With the beginning of an active swimming mode of life (neanic stage) the subadult animals left the free water column and moved into shallow water habitats. Fuciniceras showed no marked changes in the attachment structures during ontogeny. This indicates that there occur no differences in the mode of life between juvenile and adult growth stages. Based on attachment structures and shell morphology of Devonian goniatites their relation to the systematic position permits statements about probable phylogenetic relationships between the Cheiloceratidae and Tornoceratidae. In some cases attachment structures of ammonites permit statements about phylogenetic relationships on family and genus level.

Morfometria craniana do boto (Phocoena phocoena) na costa portuguesa

Eventos climáticos extremos poderão ter conduzido à instabilidade de habitats e em última instância à sua fragmentação, causando repercussões ainda visíveis nos predadores de topo, tais como o boto (Phocoena phocoena). Consequentemente, os indivíduos que não se adaptaram, tiveram de procurar novos habitats com as respetivas condições ideais, nomeadamente os indivíduos da população de botos do Atlântico Este (norte e sul da Baía de Biscaia). O presente estudo focou-se em indivíduos da costa portuguesa (representando uma amostra da população residente a sul da Baía de Biscaia) e, recorrendo a informação proveniente de estudos previamente realizados, procurou salientar diferenças entre os botos que habitam ao longo do Atlântico Este. Foi aplicado um método de limpeza e branqueamento em crânios de boto, para posterior medição. Foram medidos 65 crânios de botos (programa Image J®), providenciados pela rede de arrojamentos de animais marinhos e obtidos no âmbito do projeto LIFE+ MarPro. As comparações das medidas dos crânios entre géneros foram realizadas a partir de modelos alométricos (programa GraphPad Prism ®) e as comparações entre géneros de cada estágio de desenvolvimento foram efetuadas com recurso a uma análise de PERMANOVA unifatorial (usando distâncias euclidianas), através do programa PAST® v. 2.12. Concluiu-se que na população em estudo, tanto as fêmeas como os machos apresentaram um modelo de alometria negativa. Reportou-se que as fêmeas apresentam comprimentos corporais superiores aos machos, assim como comprimentos e larguras cranianas. Comparativamente aos indivíduos da população a norte da Baía de Biscaia, a amostra de estudo da população do sul da Baía de Biscaia (representada pelos indivíduos da costa portuguesa) apresentou maiores comprimentos corporais e cranianos e maior largura craniana. Estes resultados corroboram observações prévias sobre a população de botos do Atlântico, que detetaram já diferenças genéticas e partilha limitada de genes, diferenças nos hábitos alimentares e habitats distintos nos botos de norte e sul da Baía de Biscaia.

Adenocarcinomas nasossinusais: experiência do Serviço de Otorrinolaringologia do Instituto Português de Oncologia de Lisboa entre 2000 e 2014

Objetivos: Analisar dados demográficos, apresentação clínica, fatores de risco, opções terapêuticas e sobrevida de doentes com adenocarcinoma nasossinusal. Material e Métodos: Estudo retrospetivo de doentes com Adenocarcinoma Nasossinusal tratados entre 2000 e 2014, no IPOFGL. Resultados: Identificamos 33 doentes com diagnóstico de Adenocarcinoma. A idade média foi de 65.6 anos. A terapêutica mais comum foi cirurgia com radioterapia adjuvante. A sobrevida global e livre de doença aos 3 anos foi de 57.6% e 40.5%. A invasão do seio esfenoidal (p=0.038) e da base do crânio (p=0.003) influenciaram a sobrevida global. O desenvolvimento de metástases à distância teve impacto sobre a sobrevida livre de doença (p=0.01). Conclusões: Os Adenocarcinomas são tumores raros. A excisão da lesão toma um papel determinante no tratamento dos doentes. Na nossa amostra, a invasão do seio esfenoidal, da base do crânio e o desenvolvimento de metástases à distância estão associados a um pior prognóstico.

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Malignant Otitis Externa and Stroke

Malignant otitis externa (MOE) is an aggressive but benign entity which evolves into skull base osteomyelitis. An 81-year-old female patient was admitted for left hemiparesis and homonymous hemianopia. She complained of headache radiating to the right cervical area. A recent history of recurrent otitis media was present. Head and neck imaging showed an ischemic infarction (right temporo-occipital) and a parapharyngeal soft tissue mass originating in an external and medial ear infection. Culture samples revealed Pseudomonas aeruginosa infection leading to the diagnosis of Malignant otitis externa (MOE). Parenteral antibacterial therapy and hyperbaric oxygen therapy resulted in improvement.

Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management

Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method) is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females) who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60) and mean BMI was 37.7 kg/m² (range 30-48). All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa) stitches, using a cinch device to bring them nearer and form a plication. Results: A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Conclusions: Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ?

International audience

Evaluación de la posición hioidea en radiografías de pacientes clase I, II y III esqueletales entre 9 y 18 años de edad registrados en el período 2012 y 2015, de un Centro Radiológico de la Ciudad de Cuenca

Objetivo: El objetivo del presente estudio descriptivo, fue evaluar la posición del hueso hioides en los diferentes patrones esqueletales de Clase I, II y III mediante el trazado cefalométrico del triángulo hioideo propuesto por Bibby y Preston, estableciendo diferencias entre cada clase esqueletal. Materiales y métodos: La muestra consistió en 161 radiografías cefálicas laterales digitales, correspondientes a individuos de ambos sexos (75 hombres y 86 mujeres), entre edades de 9 y 18 años, las mismas que fueron divididas en tres subgrupos (Clase I, clase II y clase III) de acuerdo a los ángulos ANB y APDI. Se determinó la posición anteroposterior, vertical y angular del hueso hioides mediante el trazado cefalométrico del triángulo hioideo siendo el mentón, la tercera vértebra cervical y el hueso hioides las estructuras anatómicas utilizadas para el trazado del mismo. Se obtuvieron medidas estándar para cada clase esqueletal. Resultados: Se observaron diferencias estadísticamente significativas en la medida de H-Rgn entre clase I y II y entre clase II y III (p<0,005). El valor del ángulo del plano hioidal presentó diferencias estadísticamente significativas entre clase I y III y entre clase II y III (p<0,005). Se evidenciaron diferencias estadísticamente significativas entre hombres y mujeres con clase I esqueletal en la medida H-Rgn (p<0,005). Conclusiones: La posición del hueso hioides varía en los diferentes patrones esqueletales. Sin embargo, su posición en relación a la columna cervical presenta menos variabilidad que su relación con la mandíbula

Relación cráneo cervical en pacientes clase I, II, y III esqueletal entre 9 y 18 años de edad, mediante radiografías cefálicas laterales de un centro radiológico de la ciudad de cuenca.

El objetivo de este estudio fue determinar la relación cráneo cervical en pacientes clases I, II y III esqueletal entre 9 y 18 años de edad, mediante radiografías cefálicas laterales de un centro radiológico de la ciudad de Cuenca, utilizando el análisis cráneo cervical propuesto por Rocabado. Materiales y métodos: Fueron analizadas 161 radiografías cefálicas laterales digitales, de ambos sexos, con edad promedio de 12.3 años (DE± 2.4). Se incluyeron radiografías de individuos con dentición mixta y permanente, sin tratamiento ortodóncico y en donde se observe hasta la sexta vértebra cervical. Fueron excluidas las radiografías de pacientes con mordida abierta, traumatismos maxilofaciales y radiografías de mala calidad. Las telerradiografías fueron analizadas mediante el programa cefalométrico Nemoceph NX, donde se determinó el patrón esqueletal mediante los ángulos SNA, SNB, ANB y APDI. La evaluación de la postura cervical, se realizó mediante el análisis cráneo cervical propuesto por Rocabado. Se obtuvo el índice de concordancia (ICC=0.94). Mediante estadística descriptiva se analizaron las relaciones entre variables usando la prueba de Chi cuadrado y T de Student. Resultados: Se encontró mayor rotación posterior de cráneo en clase I y II esqueletal, encontrándose diferencias estadísticamente significativas respecto al ángulo cráneo vertebral entre hombres y mujeres en individuos clase II esqueletal. Las mujeres presentaron mayor rotación posterior de cráneo a diferencia de los hombres. (p=0.004). En clase III se encontró una relación normal. El espacio suboccipital en las tres clases esqueletales se presento con normalidad. No se encontró diferencia significativa respecto a la edad. Conclusiones: La relación cráneo cervical se presenta con una tendencia a la rotación posterior de cráneo, influida fuertemente por el sexo del individuo. El espacio suboccipital es normal en clase I y II esqueletal y con tendencia al aumento en clase III.

Fratura traumática do osso temporal : diagnóstico, sequelas e tratamento

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Brachycephalic obstructive airway syndrome : a review with six clinical cases

Dissertação de Mestrado Integrado em Medicina Veterinária

Emerging pathogens in the central nervous system: a cerebral abscess by Streptococcus porcinus

Brain abscesses can cause an incapacitating neurological deicit in up to 50% of patients, thus the reduction of these sequelae becomes the main goal of its timely and speciic surgical and medical treatment. With technological advances in bacteriological identiication and diagnostic imaging, the clinical suspicion can be conirmed, and the speciic etiological agent can be identiied in a larger number of cases. New pathogens have emerged through this process, such as Streptococcus porcinus, in which the ability to affect the central nervous system has not been documented. A clinical case is presented of a brain abscess in an immunocompetent patient, and its favorable response to surgical drainage t hrough a skull burr h ole and nee dle aspiration with antibiotic therapy (ceftriaxone, metronidazole and vancomycin) is discussed.

Pleistocene mammals from the southern Brazilian continental shelf

Fossils of terrestrial mammals preserved in submarine environment have been recorded in several places around the world. In Brazil such fossils are rather abundant in the southernmost portion of the coast, associated to fossiliferous concentrations at depths up to 10 m. Here is presented a review of such occurrences and the first record of fossils in deeper areas of the continental shelf. The fossils encompass several groups of both extinct and extant mammals, and exhibit several distinct taphonomic features, related to the marine environment. Those from the inner continental shelf are removed and transported from the submarine deposits to the coast during storm events, thus forming large konzentrat-lagerstatte on the beach, called "Concheiros". The only fossils from deeper zones of the shelf known so far are a portion of a skull, a left humerus and of a femur of Toxodon sp. and a lower right molar of a Stegomastodon waringi, all collected by fishermen at depths around 20 m. The presence of fossils at great depths and distances from the present coastline, without signs of abrasion and far from areas of fluvial discharges does indicate that these remains have not been transported from the continent to the shelf, but have been preserved directly on the area that today correspond to the continental shelf. These remains indicate the existence of large fossiliferous deposits that have developed during periods of sea-level lowstand (glacial maxima) and have been submerged and reworked by the sea-level rise at the end of the last glaciation. (C) 2010 Elsevier Ltd. All rights reserved.

Software for Designing Custom Orbital-Craniofacial Implant Plans

Purpose: Custom cranio-orbital implants have been shown to achieve better performance than their hand-shaped counterparts by restoring skull anatomy more accurately and by reducing surgery time. Designing a custom implant involves reconstructing a model of the patient's skull using their computed tomography (CT) scan. The healthy side of the skull model, contralateral to the damaged region, can then be used to design an implant plan. Designing implants for areas of thin bone, such as the orbits, is challenging due to poor CT resolution of bone structures. This makes preoperative design time-intensive since thin bone structures in CT data must be manually segmented. The objective of this thesis was to research methods to accurately and efficiently design cranio-orbital implant plans, with a focus on the orbits, and to develop software that integrates these methods. Methods: The software consists of modules that use image and surface restoration approaches to enhance both the quality of CT data and the reconstructed model. It enables users to input CT data, and use tools to output a skull model with restored anatomy. The skull model can then be used to design the implant plan. The software was designed using 3D Slicer, an open-source medical visualization platform. It was tested on CT data from thirteen patients. Results: The average time it took to create a skull model with restored anatomy using our software was 0.33 hours ± 0.04 STD. In comparison, the design time of the manual segmentation method took between 3 and 6 hours. To assess the structural accuracy of the reconstructed models, CT data from the thirteen patients was used to compare the models created using our software with those using the manual method. When registering the skull models together, the difference between each set of skulls was found to be 0.4 mm ± 0.16 STD. Conclusions: We have developed a software to design custom cranio-orbital implant plans, with a focus on thin bone structures. The method described decreases design time, and is of similar accuracy to the manual method.