Ruptura isolada da pelve renal secundária ao trauma abdominal contuso

Blunt rupture of the renal pelvis is a exceedingly rare injury. Hematuria is absent in one-third of cases. Such injuries are usually caused by desacceleration forces. Despite improved imaging techniques, diagnosis of this injuries is frequently delayed. Diagnosis is suggested by the presence of massive medial extravasation of contrast material at excretory urography or computed tomography. Surgical treatment consists in pyeloplasty or pyeloraphy with stent placement (double J) or nephrostomy.

Cirurgia para controle do dano: uma revisão

Damage control surgery is one of the major advances in surgical practice in the last 20 years. The indications for damage control surgery are: the need to terminate a laparotomy rapidly in an exsanguinating, hypothermic patient who had developed a coagulopathy and who is about to die on the operating table; inability to control bleeding by direct hemostasis; and inability to close the abdomen without tension because of massive visceral edema and a tense abdominal wall. Damage control surgery has three phases: 1) laparotomy to control hemorrhage by packing, shunting, or balloon tamponade, or both; control of intestinal spillage by resection or ligation of damaged bowel, or both; 2) physiological resuscitation to correct hypothermia, metabolic acidosis, and coagulopathy. 3) planned reoperation for definitive repair. Damage control surgery is appropriate in a small number of critically ill patients who are likely to require substantial hospital resources. However, there are many questions that need to be answered. Who is the patient elected for this surgery? When is the ideal time to make the decision? Which are the parameters that indicate to the surgeons the moment to re-operate the patient? How to treat the long-term complications? In the present review we described some historical aspects, indications, technical aspects, advantages and disadvantages of this procedure, as well as its physiological consequences and morbidity and mortality rates of damage control surgery. Damage control surgery offers a simple effective alternative to the traditional surgical management of complex or multiple injuries in critically injured patients.

Infecção por micobactérias de crescimento rápido após procedimentos videocirúrgicos - a hipótese do glutaraldeído

Between August 2006 and February 2007, in the state of Rio de Janeiro, Brazil, a massive outbreak of RGM infections after video laparoscopy was mainly associated to the recently described Mycobacterium massiliense species. All confirmed and probable cases reports described the use of high-level disinfection of medical devices by using 2% glutaraldehyde (2% GA) for 30 min before the surgical procedures. We investigated the susceptibility of the M. massiliense isolates recovered during the outbreak to high-level disinfection after 30 min, 1h, 6h and 10h of exposure to the commercial disinfectants. Reference strains for official mycobactericidal tests such as Mycobacterium abscessus, Mycobacterium bovis, Mycobacterium chelonae, Mycobacterium neoaurum and Mycobacterium smegmatis were included as controls. Although all the reference strains were eliminated in 30 min of exposure to 2% GA, we observed the recovery of all M. massiliense clinical isolates even after 10h of exposure. This study suggests that failures in high-level disinfection and the high tolerance of these M. massiliense clinical strains to the 2% GA were strongly associated to the magnitude of the outbreak.

Pneumoperitônio idiopático: relato de caso

Idiopathic pneumoperitoneum is considered a rare condition, as only twenty cases have been described in the last thirty years. The authors report a case of idiopathic massive pneumoperitoneum in a patient aged 45, showing the possible causes of this clinical picture based on a review of medical literature.

Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

Objective: To evaluate the anatomic topographic relation between the sciatic nerve in relation to the piriform muscle and the posterior portal for the establishment of hip arthroscopy.Methods: We dissected 40 hips of 20 corpses of adult Brazilians, 17 male and three female, six black, six brown and eight white. We studied the anatomical relationship between the sciatic nerve and the piriform muscle with their variations and the distance between the lateral edge of the sciatic nerve and the posterior portal used in hip arthroscopy. We then classified the anatomical alterations found in the path of the sciatic nerve on the piriform muscle.Results: Seventeen corpses had bilateral relationship between the sciatic nerve and the piriform muscle, i.e., type A. We found the following anatomical variations: 12.5% of variant type B; and an average distance between the sciatic nerve and the portal for arthroscopy of 2.98cm. One body had type B anatomical variation on the left hip and type A on the right.Conclusion: the making of the posterior arthroscopic portal to the hip joint must be done with careful marking of the trochanter massive; should there be difficult to find it, a small surgical access is recommended. The access point to the portal should not exceed two centimeters towards the posterior superior aspect of the greater trochanter, and must be made with the limb in internal rotation of 15 degrees.

Uuden teknologiayrityksen kärkikäyttäjälähtöinen tuotekonseptointi

Työssä haluttiin tuottaa tietoa päätöksenteon tueksi tuotesuunnittelun tarpeisiin sekä vähentää päätöksentekoon liittyvää epävarmuutta. Koska kiinteistöautomaatio oli nähty erityisen kiinnostavana alueena, haluttiin ensinnäkin tietoa siitä, mitkä tekijät lisäävät järjestelmien kysyntää. Toiseksi tarvittiin esimerkkejä eli konsepteja siitä, millaisiksi uusiksi tuotteiksi teknologiset mahdollisuudet ja markkinoiden haasteet voivat konkretisoitua. Teoriatarkastelussa saatiin tunnistettua viisi kiinteistöautomaatiojärjestelmien kysyntää lisäävää päätekijää: teknologioiden ja palveluiden kehitys, ilmastonmuutos ja energiavarojen väheneminen, kulttuurimuutokset, muutokset koko arvoketjussa sekä valtion toimet. Kysyntää lisäävät syyt jaettiin edelleen makrotrendeihin sekä niitä seuraaviin mikrotrendeihin. Varsinaisessa kärkikäyttäjätutkimuksessa kehitettiin tunnistamattomiin käyttäjätarpeisiin perustuen kolme tuotekonseptia: kiinteistöautomaatiojärjestelmä, vedenlaadun tarkkailujärjestelmä sekä murtohälytysjärjestelmä. Kaikki näistä perustuvat samaan tuotealustaan. Kiinteistöautomaatiojärjestelmä soveltuu kiinteistöjen kokonaisvaltaiseen ja helppokäyttöiseen ohjaukseen sekä energiasäästöjen saavuttamiseen. Tuote räätälöidään erikseen jokaiseen kohteeseen lukuun ottamatta esimerkiksi valmistalojen yhteydessä toimitettavia vakiopaketteja. Vedenlaadun tarkkailujärjestelmä soveltuu puolestaan tilanteisiin, joissa tarvitaan nopea todennus veden puhtaudesta, mutta joissa epäpuhtauksien välitön erittely ei ole tarpeellista. Tuote sopii esimerkiksi kaivos- ja paperiteollisuusyritysten käyttöön. Kolmatta tuotekonseptia, murtohälytysjärjestelmää, voidaan hyödyntää useassa eri kohteessa samanaikaisesti. Järjestelmä on kylmyyden- ja kosteudenkestävä ja sen ensisijaisia käyttökohteita ovat vapaa-ajan asunnot, veneet sekä matkailuautot ja -vaunut.

Curbing Inflammation in hemorrhagic trauma: a review

Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it.

Spontaneous rupture of renal angiomyolipoma during pregnancy

Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodinamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus.

Main diseases of pejerrey (Odontesthes bonariensis) in central Argentina

Argentina's central region includes an important area covered by shallow pampean lakes and dams. In these environments, fishing of pejerrey Odontesthes bonariensis Valenciennes, 1835 (Pisces, Atherinopsidae), the most important fresh-water fish of the country, is a relevant social activity and also a considerable economic resource. The main diseases found in this species were studied from 1992 to 2003 in the provinces of Córdoba, La Rioja and Santa Fe (30º and 35º S, 61º and 67º W). Most cases were registered in high temperature months. Lernaea sp and Aeromonas hydrophila were the etiological agents most frequently found. The trophic characteristics of the aquatic environments enhanced disease processes and caused massive death of O. bonariensis, due to complex hydrochemical interactions.

Spontaneous poisoning by larvae of Perreyia flavipes (Pergidae) in sheep

From a flock of 175 Texel sheep 25 animals died after consumption of a sawfly larvae subsequently identified as Perreyia flavipes. The disease occurred in June-July 2006 on a farm located in the county of Encruzilhada do Sul, Rio Grande do Sul, Brazil. Although there were 11 cattle in the same paddock, none of them was affected. High numbers of compact masses containing up to 150 larvae were scattered in the paddock where the animals were grazing. Most affected sheep showed severe apathy during 24-36 h before death, but weakness, muscular tremors and depression were also observed. Necropsy was performed on six sheep and the main macroscopic lesions were hemorrhages in the subcutaneous tissues, endocardium, gallbladder wall, and abomasal mucosa. In all animals was found hydrothorax, hydropericardium, ascites, and mild jaundice. Edema in the abomasal folds, mesentery, perirenal tissues, and gallbladder wall were also seen. The livers were yellowish with disseminated pinpoint hemorrhages in the parenchyma and had an enhanced lobular pattern. Perreyia flavipes larval body fragments and heads were found in the forestomach contents of the six sheep. Feces were scant, dry and formed balls coated by mucus and streaks of blood. Similar contents were also present at the end of the cecum. Prominent microscopic lesions included severe and diffuse periacinar or massive necrosis of hepatocytes associated with multifocal random hemorrhages. Diffuse necrosis of lymphoid follicles in lymph nodes and Peyer's patches, lymphoid depletion and necrosis in germinative centers of the spleen, and diffuse vacuolization in the renal tubular epithelia were also seen.

Sawfly larval poisoning in cattle: Report on new outbreaks and brief review of the literature

Sawfly larval poisoning (SLP) is an acute hepatotoxicosis documented in livestock in Australia, Denmark and in countries of South America. It is caused by the ingestion of the larval stage of insects of the suborder Symphyta, order Hymenoptera, commonly known as "sawfly". Three species of sawfly are reportedly involved in the toxicosis. The insect involved in Australian SLP is Lophyrotoma interrupta (Pergidae), in Denmark the cause of SLP is the ingestion of the larvae Arge pullata (Argidae), and in South American countries documented outbreaks of SLP were caused by the ingestion of yet another sawfly, Perreyia flavipes (Pergidae). In all geographical areas where it occurred, SLP causes important livestock losses. In cattle, as well as in other affected species, the disease has a short clinical course and in many outbreaks affected cattle can be found dead. When observed, clinical signs include apathy, recumbence, tremors, paddling movements and death in 24-48 hours. Neurological signs such aggressiveness attributable to hepatic encephalopathy are also observed. In cases with a more protracted course icterus and photodermatitis may develop. Gross findings included ascites, petechiae and ecchymosis over serosal surfaces of thoracic and abdominal cavities, and an enlarged liver that displays accentuation of the lobular pattern and edema of the gall bladder wall. Sawfly larval body fragments and heads are consistently found in the fore stomachs and occasionally abomasum of affected cattle. Main microscopic lesions are restricted to the liver and consist of centrolobular (periacinar) to massive hepatocellular necrosis. In most lobules necrotic areas extended up to the portal triads where only a few viable hepatocytes remain. Mild to moderate lymphocyte necrosis is seen in lymphatic tissues. Cases occur in the winter months when the larval stages of the sawfly are developing. D-amino acid-containing peptides have been found to be the toxic principle in each sawfly involved in SLP. The octapeptide lophyrotomin is the major toxin in the in the larvae of Australian and Danish sawflies and is present in small amounts in the larvae of South American sawfly. The heptadecapeptide pergidin is the main toxin in the South American sawfly while small amounts of pergidin have been found in the other two species of toxic sawfly. During the winter of 2011 (July-August) four outbreaks of SLP were diagnosed in the State of Rio Grande do Sul, Brazil. The findings in those outbreaks are reported here and a brief review of the literature regarding SLP around the world is provided.

Treatment of NI-containing acidic mine waters with calcite side-stones

Acid mine drainage (AMD) presents a serious problem for the environment for the massive formation of acidic leachates containing heavy metals. The present work deals with the AMD treatment using neutralizing limestone side-products. The conventional methods for prevention, mitigating and control of AMD formation are described. The experimental testing of Nordkalk Oy calcite-containing side-stones for acid neutralizing and removal of nickel from solutions presents the research objective. The batch experiments in acid neutralizing with subsequent metal content analysis were carried out. The results showed the dependence of pH on the dose of neutralizing material and the exposure time. The nickel removal, unlike iron, within the pH range from 1.2 to 6.0 appeared to be inadequate. The further research on nickel co-precipitation with iron and aluminium may appear to be necessary together with testing of alkalinity strengthening materials.

Licensing Model Development for Small Modular Reactors (SMRs) - Focusing on the Finnish Regulatory Framework

Recently, Small Modular Reactors (SMRs) have attracted increased public discussion. While large nuclear power plant new build projects are facing challenges, the focus of attention is turning to small modular reactors. One particular project challenge arises in the area of nuclear licensing, which plays a significant role in new build projects affecting their quality as well as costs and schedules. This dissertation - positioned in the field of nuclear engineering but also with a significant section in the field of systems engineering - examines the nuclear licensing processes and their suitability for the characteristics of SMRs. The study investigates the licensing processes in selected countries, as well as other safety critical industry fields. Viewing the licensing processes and their separate licensing steps in terms of SMRs, the study adopts two different analysis theories for review and comparison. The primary data consists of a literature review, semi-structured interviews, and questionnaire responses concerning licensing processes and practices. The result of the study is a recommendation for a new, optimized licensing process for SMRs. The most important SMR-specific feature, in terms of licensing, is the modularity of the design. Here the modularity indicates multi-module SMR designs, which creates new challenges in the licensing process. As this study focuses on Finland, the main features of the new licensing process are adapted to the current Finnish licensing process, aiming to achieve the main benefits with minimal modifications to the current process. The application of the new licensing process is developed using Systems Engineering, Requirements Management, and Project Management practices and tools. Nuclear licensing includes a large amount of data and documentation which needs to be managed in a suitable manner throughout the new build project and then during the whole life cycle of the nuclear power plant. To enable a smooth licensing process and therefore ensure the success of the new build nuclear power plant project, management processes and practices play a significant role. This study contributes to the theoretical understanding of how licensing processes are structured and how they are put into action in practice. The findings clarify the suitability of different licensing processes and their selected licensing steps for SMR licensing. The results combine the most suitable licensing steps into a new licensing process for SMRs. The results are also extended to the concept of licensing management practices and tools.

Iran's domestic and foreign policies

Iran has a reputation of being a problematic country. Right now, it is proceeding with its nuclear program despite the opposition of the West and neighboring countries and the massive sanctions inflicted upon it. The country is also struggling with domestic issues. Half of Iran’s population belongs to different ethnic or religious minorities. They have poor rights to express their culture in the country, which is a cause of dissatisfaction among non-Shiite and non-Persian citizens. After the Arab Spring, the situation in Iran is getting more topical than ever. In the Syrian conflict, the Shiite Iran is constantly giving support to al-Assad’s regime. These are all factors that have aggravated the already irritated relations between Iran and the West.

Chromatoid body mediated RNA regulation in mouse male germline

Male germ cell differentiation, spermatogenesis is an exceptional developmental process that produces a massive amount of genetically unique spermatozoa. The complexity of this process along with the technical limitations in the germline research has left many aspects of spermatogenesis poorly understood. Post-meiotic haploid round spermatids possess the most complex transcriptomes of the whole body. Correspondingly, efficient and accurate control mechanisms are necessary to deal with the huge diversity of transcribed RNAs in these cells. The high transcriptional activity in round spermatids is accompanied by the presence of an uncommonly large cytoplasmic ribonucleoprotein granule, called the chromatoid body (CB) that is conjectured to participate in the RNA post-transcriptional regulation. However, very little is known about the possible mechanisms of the CB function. The development of a procedure to isolate CBs from mouse testes was this study’s objective. Anti-MVH immunoprecipitation of cross-linked CBs from a fractionated testicular cell lysate was optimized to yield considerable quantities of pure and intact CBs from mice testes. This protocol produced reliable and reproducible data from the subsequent analysis of CB’s protein and RNA components. We found that the majority of the CB’s proteome consists of RNA-binding proteins that associate functionally with different pathways. We also demonstrated notable localization patterns of one of the CB transient components, SAM68 and showed that its ablation does not change the general composition or structure of the CB. CB-associated RNA analysis revealed a strong accumulation of PIWI-interacting RNAs (piRNAs), mRNAs and long non-coding RNAs (lncRNAs) in the CB. When the CB transcriptome and proteome analysis results were combined, the most pronounced molecular functions in the CB were related to piRNA pathway, RNA post-transcriptional processing and CB structural scaffolding. In addition, we demonstrated that the CB is a target for the main RNA flux from the nucleus throughout all steps of round spermatid development. Moreover, we provided preliminary evidence that those isolated CBs slice target RNAs in vitro in an ATPdependent manner. Altogether, these results make a strong suggestion that the CB functions involve RNA-related and RNA-mediated mechanisms. All the existing data supports the hypothesis that the CB coordinates the highly complex haploid transcriptome during the preparation of the male gametes for fertilization. Thereby, this study provides a fundamental basis for the future functional analyses of ribonucleoprotein granules and offers also important insights into the mechanisms governing male fertility.