Abstract Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group – 2010–2014; and MDT group – 2015–2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy – one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT). Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) – 2010–2014; e grupo MDT – 2015–2021. Análise descritiva de suas características e desfechos maternos. Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto – uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades. Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Abstract Introduction: Chimney EVAR (ChEVAR) for the treatment of complex abdominal aortic aneurysm (AAA) has been largely relegated for when fenestrated endografts are unavailable, especially due to durability concerns. However, the off-the-shelf nature of ChEVAR makes it a good option for emergent AAA repair. We report our institutional experience in ChEVAR in an urgent setting. Methods: ChEVAR procedures were collected f rom 2019 to 2023 in a tertiary hospital, and a retrospective analysis was performed. This includes gathered information f rom electronic medical records, surgical reports and the picture archiving system. Descriptive statistics were applied. The main endpoints were technical success,30-day and 1-year survival. Results: Five patients were submitted to urgent aneurysm repair using the chEVAR technique. Average age was 73,4 years and all patients were male. Arterial hypertension was present in 100% patients and all patients were ASA 4. Indications for surgery were post EVAR type 1a endoleak with associated rupture or abdominal pain in two patients; symptomatic/contained rupture of pararenal AAA in two patients; and contained rupture of a thoracoabdominal aneurysm in one patient. A total of eight target vessels were catheterized: two patients required single-vessel chimney and the remainder two-vessel chimney. Target vessels were two superior mesenteric arteries and six renal arteries. Technical success rate was 100% and 30-day mortality was 0%. There were no major complications. Follow-up time is 20.2 months (4.7-38). Target vessel patency during the follow-up period was 87.5%. Three patients (60%) died due to non-aortic related pathologies, on average 18 months after surgery (4.7-38), with a 1-year survival of 80%. Conclusion: Our experience with ChEVAR for emergent AAA repair is satisfactory, with high technical success rates and low short-term mortality. Sac regression, low rates of target vessel occlusion and type 1a endoleaks reveal a favourable profile for aneurysm exclusion. ChEVAR is a viable option in emergent setting for patients unfit for open repair.

Abstract This article focuses on the emergence and development of rehabilitation operations with façade retention and interior demolition in the city of Lisbon. This type of intervention, commonly referred to as façade work, became widespread in the city from the end of the nineteen hundreds, being supported by a cultural and socio-economic context, which would even be shaped by legislation. Interventions of façade reconstruction have antecedents in the history of Architecture and Urbanism, however, the proliferation of reverse operations is controversial in the disciplinary debate. This article summarizes, delimits and interprets the roots of this type of intervention in Lisbon. It intends to clarify the motives and context of its vulgarization, including the socio-economic, cultural and normative situation, pondering also on its effects and limitations for the built space. For this purpose, it observes a series of interventions in Avenida da Liberdade, considered the archetypical urban axis of bourgeois Lisbon. From the reading of case studies and their context two chronological moments emerge: the pre-normative façadeism between 1980 and 1995, followed by a post-normative one, which consolidates itself in the first decade of the new century and is reflected in the present moment.

Resumo Este artigo incide sobre o surgimento e desenvolvimento de operações de reabilitação com retenção da fachada e demolição do interior na cidade de Lisboa. Este tipo de intervenção, comumente designado de fachadismo, generalizou-se na cidade desde o final de novecentos, sendo suportado por um contexto cultural e socioeconómico, que seria inclusivamente plasmado pela normativa. As intervenções de reconstrução de fachadas têm antecedentes na história da Arquitetura e do Urbanismo; todavia, a proliferação de operações inversas é controversa no debate disciplinar. Este artigo resume, delimita e interpreta as raízes deste tipo de intervenção em Lisboa. Pretende clarificar os motivos e contexto da sua vulgarização, incluindo a situação socioeconómica, cultural e normativa, ponderando igualmente sobre os seus efeitos e limitações para o espaço edificado. Para este efeito, observa uma série de intervenções na Avenida da Liberdade, considerada o eixo urbano arquétipo da Lisboa burguesa. Da leitura de casos de estudo e do seu contexto emergem dois momentos cronológicos: o fachadismo pré-normativo entre 1980 e 1995, seguindo de um pós-normativo, que se consolida na primeira década do novo século e se reflete no momento presente.

Abstract Introduction: Depression in early childhood was first described by Spitz in 1940. The literature reports an association between depressive symptoms in infants and early affective deprivation, pinpointing maternal depression as a major risk factor. However, there is little evidence on the impact of maternal comorbid depression and gender dysphoria on the risk of depression in early childhood. Case report: A 25-month-old toddler was referred to the Child and Adolescent Psychiatry Outpatient Department for persistent irritability and sleep disturbances. His mother had persistent depressive disorder and had never felt comfortable in her role as a mother, struggling with caregiving and responding to the child’s emotional needs. During follow-up, maternal symptoms of gender dysphoria were identified. Discussion: Mother-infant bonding and responsive caregiving are essential for adequate socioemotional development.

Resumo Introdução: A depressão na primeira infância foi descrita pela primeira vez por Spitz em 1940. A literatura relata a associação entre sintomas depressivos na criança e privação afetiva precoce, sendo a depressão materna um fator de risco amplamente reconhecido. No entanto, há pouca evidência sobre o impacto da disforia de género materna no desenvolvimento de depressão na primeira infância. Caso clínico: Uma criança de 25 meses foi referenciada para a consulta de Psiquiatria da Infância e da Adolescência por irritabilidade persistente e perturbações do sono. A mãe apresentava perturbação depressiva persistente e manifestava grande dificuldade na resposta às necessidades emocionais da criança. Durante o seguimento, foi identificada sintomatologia materna de disforia de género. Discussão: A qualidade da relação mãe-bebé e dos primeiros cuidados são requisitos fundamentais para o normal desenvolvimento psicoafetivo infantil.

RESUMO O uso de bioestimulantes em mudas de café pode promover ganhos em seu crescimento e na sua qualidade. Assim, o objetivo desse trabalho foi avaliar as características de crescimento e qualidade de mudas de café arábica sob o efeito da aplicação dos bioestimulantes nicotinamida e Azospirillum brasilense. O delineamento experimental utilizado foi o de blocos casualizados, em esquema fatorial 5 × 2, com quatro repetições. Os tratamentos resultaram da utilização de cinco doses de nicotinamida (0, 30, 60, 90 e 120 mg L-1 de água) combinadas com a ausência e presença de Azospirillum brasilense aplicadas em mudas de Coffea arabica da cultivar Catuaí Vermelho 144. Foram avaliadas a altura de planta, diâmetro do caule, número de folhas, área foliar, massa seca da parte aérea, massa seca da raiz, razão entre altura e diâmetro do caule, razão entre massa seca da parte aérea e massa seca da raiz, razão entre altura e massa seca da parte aérea e índice de qualidade Dickson. A utilização conjunta ou isolado do A. brasilense e da nicotinamida, até a dose de 33.5 mg L-1, aumentou características biométricas e acúmulo de massa seca. No entanto, a utilização de doses de nicotinamida entre 30 e 61,8 mg L-1 aumentou da qualidade de mudas de Coffea arabica. Foi verificado efeito sinérgico do uso de A. brasilense e nicotinamida para crescimento e qualidade de mudas.

ABSTRACT The use of biostimulants in coffee seedlings can promote gains in their growth and quality. Thus, this study aimed to evaluate the growth and quality characteristics of Coffea arabica seedlings under the effect of the nicotinamide and Azospirillum brasilense application. The experimental design was randomized blocks with treatments arranged in a 5 × 2 factorial scheme, with four replicates. The treatments resulted from the use of five doses of nicotinamide (0, 30, 60, 90, and 120 mg L-1 of water) combined with the absence and presence of Azospirillum brasilense applied to Coffea arabica seedlings from Catuaí Vermelho 144 cultivar. Plant height, stem diameter, number of leaves, leaf area, shoot dry mass, root dry mass, plant height:stem diameter ratio, shoot:root dry mass ratio, plant height:shoot dry mass ratio, and Dickson quality index were evaluated. The combined or isolated use of A. brasilense and nicotinamide, up to a dose of 33.5 mg L-1, increased the biometric characteristics and dry mass accumulation. However, using nicotinamide doses between 30 and 61.8 g L-1 increased the quality of Coffea arabica seedlings. The synergistic effect of the use of A. brasilense and nicotinamide was verified for the growth and quality of Coffea arabica seedlings.

Abstract Objective Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Methods Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. Results A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Conclusion Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.

RESUMO A manga (Mangifera indica L.) é uma fruta tropical de grande importância no mundo. No entanto, as perdas pós-colheita dos frutos são causadas pela antracnose, doença causada principalmente por fungos fitopatogênicos do gênero Colletotrichum. Assim, este trabalho teve como objetivo estudar a morfologia, similaridade genética e patogenicidade de isolados de Colletotrichum spp. de manga no estado do Rio Grande do Norte, Brasil. A avaliação morfológica de 28 isolados, com base na cor da colônia, tamanho dos conídios e apressórios e taxa de crescimento, mostrou que os isolados pertencem à espécie C. gloeosporioides. Posteriormente, foi confirmado com oligonucleotídeos específicos para a espécie. Além disso, a avaliação combinada com RAPD (Random Amplified Polymorphic DNA) e ISSR (Inter Simple Sequence Repeats) mostrou uma similaridade genética de 0,23 entre os Isolados 12 e 21, e 0,71 entre os Isolados 2 e 4, um indicativo de alta variabilidade entre os isolados, com dissimilaridade acima de 75%. Além disso, o dendrograma gerado pelo método UPGMA indicou que os isolados foram dispostos em oito grupos, os quais não se correlacionaram com o local de coleta. Com base na patogenicidade, embora a maioria dos isolados tenha apresentado baixa virulência para a cultivar Tommy Atkins, alguns deles se mostraram altamente agressivos (Isolados 9, 15, 20, 21, 24, 26 e 27). Além disso, a patogenicidade não se correlacionou com os aglomerados. Concluindo, os resultados revelaram alta variabilidade genética e patogênica em C. gloeosporioides isolado de cultivares de manga em uma das principais regiões exportadoras do Brasil.

ABSTRACT Mango (Mangifera indica L.) is a tropical fruit of great importance in the world. However, fruit postharvest losses are caused by anthracnose, a disease caused mainly by phytopathogenic fungi from the Colletotrichum genus. Thus, this work aimed to study morphology, genetic similarity, and pathogenicity of Colletotrichum spp. isolates from mango in Rio Grande do Norte state, Brazil. Morphological evaluation of 28 isolates, based on colony color, size of conidia and appressoria, and growth rate, showed that the isolates belong to the C. gloeosporioides species. It was later confirmed with species-specific oligonucleotides. Also, combined evaluation with RAPD (Random Amplified Polymorphic DNA) and ISSR (Inter Simple Sequence Repeats) showed a genetic similarity of 0.23 between Isolates 12 and 21, and 0.71 between Isolates 2 and 4, an indication of high variability among isolates, with dissimilarity over 75%. Moreover, the dendrogram generated by the UPGMA method indicated that the isolates were arranged in eight groups, which did not correlate with the collection site. Based on pathogenicity, although most isolates showed low virulence for Tommy Atkins cultivar, some of them proved to be highly aggressive (Isolates 9, 15, 20, 21, 24, 26, and 27). Also, pathogenicity did not correlate with clusters. In conclusion, the results revealed high genetic and pathogenic variability in C. gloeosporioides isolated from mango cultivars in one of the main exporting regions in Brazil.

Abstract Introduction: Ectopic kidneys with concomitant aortoiliac aneurysmal disease have been previously reported in the literature, however its exact prevalence is unknown. The objective of this review is to summarize current knowledge on the treatment this special group of patients. Methods: A non-systematic literature research was performed on the treatment of aortoiliac aneurysmal disease in patients with ectopic kidneys. Results: Literature on the management of patients with aorto-iliac aneurysms and concomitant ectopic kidneys is limited to case reports and very small series. Treatment modalities which include open, endovascular or hybrid techniques, should preserve the variable vasculature of the ectopic kidney. Several different surgical solutions have been proposed, highlighting the uncertainty on the optimal management strategy. However, a growing number of reports suggest safety and efficacy with adapted endovascular techniques. Conclusion: In parallel to the general trend in the management of abdominal aortic aneurysm, it is expected that a growing number of patients will concomitant aorto-iliac aneurysm and ectopic kidneys will be treated with endovascular techniques.

RESUMO: Ainda não há consenso sobre qual é o protocolo mais apropriado para a produção in vivo de embriões em ovinos, apesar do crescente conhecimento. Uma abordagem para mitigar a variabilidade de resposta de ovelhas à superovulação (SOV) é iniciar a aplicação de gonadotrofinas em uma condição ovariana favorável. O presente estudo comparou três tratamentos em delineamento do tipo crossover: protocolo de SOV tradicional (TRAD) e “Dia 0” D0 SOV sem (D0-GnRH) ou com GnRH (D0+GnRH). Quinze ovelhas Santa Inês foram superovuladas com 200 mg de FSH em seis doses decrescentes e receberam PGF2α na quinta dose de FSH. As ovelhas foram submetidas a monta natural com carneiros férteis e os embriões colhidos por via cirúrgica. O número de embriões viáveis não diferiu entre os tratamentos (TRAD = 6,0 ± 4,7; D0-GnRH = 3,8 ± 6,4; D0+GnRH = 7,5 ± 6,5). Independentemente do tratamento, ovelhas com folículos ≤ 4 mm na primeira dose de FSH produziram mais embriões viáveis (9,6 ± 6,0; P < 0.05) quando comparadas aos animais que apresentavam folículos > 4 mm no início da SOV (2,9 ± 3,1 embriões viáveis). Os grupos TRAD e D0+GnRH apresentaram menor número de animais com folículos grandes (> 4 mm), no momento da primeira dose de FSH, quando comparados ao grupo D0-GnRH (P < 0,05). Em conclusão, os protocolos TRAD e D0+GnRH induziram uma condição ovariana mais favorável (folículos ≤ 4 mm) para a SOV. No entanto, os três tratamentos apresentaram eficiência semelhante em ovelhas Santa Inês.

ABSTRACT: There is still no consensus regarding the best protocol for in vivo embryo production in sheep despite increasing studies in this area. Moreover, there is variability in the response of ewes to superovulation (SOV). An approach to mitigate this inconsistency is to initiate gonadotropin administration under favorable ovarian conditions. The present study compared three treatments in a crossover design: a traditional SOV protocol (TRAD) and “Day 0” D0 SOV protocol with (D0+GnRH), or without Lecilerin (D0-GnRH). Fifteen Santa Inês ewes received 200 mg of FSH at six decreasing doses and PGF2α with the fifth dose of FSH. They were naturally mated with fertile rams and subjected to surgical embryo collection. The number of viable embryos was similar among the different treatments (TRAD = 6.0 ± 4.7; D0-GnRH = 3.8 ± 6.4; D0+GnRH = 7.5 ± 6.5). Regardless of the treatment method, ewes with follicles ≤ 4 mm, at the first FSH dose, produced more viable embryos (9.6 ± 6.0, P < 0.05) compared to ewes that had follicles > 4 mm at the beginning of the SOV (2.9 ± 3.1, viable embryos). Both the TRAD and D0+GnRH groups had fewer animals with large follicles (> 4 mm) at the first FSH dose than the D0-GnRH group (P < 0.05). In conclusion, both the TRAD and D0+GnRH treatments induced a more favorable ovarian condition (follicles ≤ 4 mm) for adequate SOV; although, all three treatments exhibited similar efficacies in Santa Inês sheep.

ABSTRACT. The aim of this study was to evaluate the influence of weaning and concentrate supplementation on the characteristics of carcass cuts and longissimus muscle of Suffolk lambs finished on a Tifton 85 (Cynodon spp.) pasture. Weaning and concentrate supplementation strategies were evaluated in four finishing systems: i) non-weaned and non-supplemented lambs; ii) non-weaned lambs supplemented with concentrate in creep feeding; iii) weaned and non-supplemented lambs; and iv) weaned lambs supplemented with concentrate. In the systems with weaning, lambs were weaned at 46 ± 6 days of age. In the systems with supplementation, the concentrate was offered daily at 2% of lambs’ body weight. Weaning led to a decrease, whereas supplementation led to an increase in carcass cut weights. Supplemented lambs had lower yields of neck and uncovered ribs, and higher yields of breast + flank and loin. The characteristics of loin eye and fat thickness over the longissimus muscle presented lower values in weaned lambs and higher values in supplemented lambs. Keeping lambs with their dams and offering concentrate supplementation until slaughter are strategies recommended to obtain heavier cuts with increased muscularity and fat content.

BACKGROUND Angiostrongylus cantonensis is the etiological agent of neuroangiostrongyliasis in humans, which is developed in gastropods and vertebrate species, mainly rodents. Human transmission occurs through consumption of molluscs and paratenic hosts infected with L3, and the migration of larvae to the central nervous system causes eosinophilic meningitis. Laboratory diagnosis is based on molecular and immunological tests, using young or adult females as a source of antigens. However, these tests give positive results only after several weeks of symptoms onset and also cross-reactions with others parasite infections may occur. OBJECTIVES The purpose of this work was to study different antigenic preparations of distinct evolutionary phases of A. cantonensis, in order to improve serological techniques for disease immunodiagnosis. METHODS For this purpose, antigenic fractions of different evolutionary forms were evaluated by Dot-enzyme-linked immunosorbent assay (Dot-ELISA) and Western blot using serum samples. FINDINGS All analysed fractions showed reactivity with serum samples from patients with neuroangiostrongyliasis, especially female membrane alkaline (FAM) and female soluble alkaline (FAS) fractions together with female soluble saline (FSS), improving the technique specificity. MAIN CONCLUSIONS The results point to the possibility of use of raw female antigens in association with alkaline membrane antigens extracted from adult worms to aid in diagnosis and helps initiate neuroangiostrongyliasis surveillance and control actions.

Resumo Introdução: O autotransplante renal (RA) é um procedimento seguro e eficaz, utilizado em patologias que requeiram reconstrução do trato urinário, cujo primeira intervenção foi descrita por Hardy em 1963. As principais indicações são doença renovascular, patologias ureterais e doença neoplásica. O RA poderá ainda ser útil em casos selecionados, como último recurso na prevenção de perda renal, especialmente quando os métodos convencionais não tiveram sucesso. Materiais e métodos: Os autores pretendem descrever quatro diferentes situações em que o RA foi a melhor solução para a patologia apresentada pelos doentes. Caso clínico I - Doente do sexo masculino, 52 anos de idade, com história de nefrectomia esquerda prévia e ureterostomia direita, no contexto de exacerbação da sua doença de Crohn. Apresentava-se agora, recentemente, com infeções urinárias de repetição e consequente disfunção renal; Caso clínico II - Doente do sexo feminino, 57 anos de idade, a quem foi diagnosticado um aneurisma da artéria renal enquanto era estudada como potencial dadora para transplante renal; Caso clínico III - Doente do sexo masculino, 49 anos de idade, admitido no Serviço de urgência vítima de trauma penetrante com atingimento abdominal e consequentes lesões ureterais e do trato intestinal. Submetido a laparotomia com reconstrução das mesmas, mas posteriores peritonites de repetição que condicionaram necessidade de ureterostomia que o doente recusava; Caso clínico IV - Doente do sexo feminino, 24 anos de idade, com o diagnóstico de Síndrome de Nutcraker após estudo realizado na sequência de admissão no Serviço de urgência com hematúria franca. Resultados: Todos os doentes foram submetidos a RA. As intervenções cirúrgicas decorreram sem intercorrências com apenas um doente a ter desenvolvido uma complicação (deiscência de ferida cirúrgica) no período pós-operatório. Foi realizado ecoDoppler e cintigrafia renal nos dias subsequentes ao procedimento que atestou a normal perfusão dos rins transplantados. Discussão: O RA foi realizado em dois doentes no contexto de lesões ureterais e perante a ausência de tratamento viável alternativo que não a perda do rim. Os outros dois casos ocorreram no contexto de patologias renovasculares complexas (uma arterial e outra venosa). Apesar da existência de opções endovasculares para estes casos, a publicação de resultados de seguimento a longo prazo ainda é escassa. Conclusão: O RA é uma opção viável em situações específicas em que é imperial a salvação do rim. Os avanços recentes com nefrectomia laparoscópica vieram reduzir de forma significativa a agressividade do procedimento cirúrgico, promovendo o RA como uma arma de tratamento de real valor no tratamento de patologias vasculares complexas, doença renovascular e ureteral traumática bem como situações médicas específicas. O RA representa assim, uma alternativa credível com resultados demonstrados e publicados, exigindo, contudo, ser realizado num Centro com elevada experiência institucional.

Abstract Introduction: Renal autotransplantation (RA) is a safe and effective procedure to reconstruct the urinary tract which first successful surgery was performed by Hardy in 1963. The main indications reported to perform a RA generally include renovascular disease, ureteral pathologies and neoplastic disease. Furthermore, RA may be useful as an ultimate recourse in preventing kidney loss in highly selected patients, especially when conventional methods have failed. Materials and Methods: The authors describe four total different situations where the RA was the key solution for the pathology initially presented. Clinical case I - A 52 years old male with a previous history of left nephrectomy due to a preceding exacerbation of his basal Crohn's disease and also a right ureter cutaneostomie, presented now with repetitive urinary tract infections that led to renal function impairment; Clinical case II - A 57 years old female with the diagnosis of renal artery aneurysm while being studied as a potential kidney donor; Clinical case III - A 49 years old male admitted in the emergency room after a penetrating trauma which conditioned bowel and ureteral lesions with postoperative consecutive and recurrent peritoneal infections that compounded a necessity for a left ureterostomy, that the patient vehemently refused; Clinical case IV - A 24 years old female with the diagnosis of Nutcracker syndrome identified after being studied regarding repetitive urgency admissions with frank haematuria. Results: Every patient was submitted to laparoscopic nephrectomy, ex-vivo reconstruction, if necessary, and kidney transplantation to the iliac fossa. The interventions were uneventful and only one patient faced a minor post-operative complication (surgical wound dehiscende). We performed an ultrasound and renal scintigraphy evaluation on following days after each procedure to attest normal renal perfusion. Discussion: The RA were conducted in two patients with ureteral cutaneostomie because there was no viable alternative but kidney loss. The other two clinical cases were treated with RA because they concerned a complex renovascular disease (one arterial and the other venous). Despite the existence of an endovascular option for these patients, long term follow-up studies are still lacking. Conclusion: The RA is a viable option in specific situations for kidney salvage. The recent development of laparoscopic nephrectomy significantly decreased the surgical hostility to the patient and promoted the RA as a value option for the treatment of complex vascular pathologies, traumatic disease and specific medical situations. It represents a credible alternative with attested results already described in the literature thus requiring a vast Institutional experience with conventional renal transplantation.

Resumo Objetivo O objetivo do presente trabalho foi comparar a medição da versão do componente acetabular em radiografias em incidência anteroposterior (AP) e crosstable após artroplastia total do quadril (ATQ). Métodos Foram selecionadas radiografias de 60 quadris com ATQ primário. A versão foi calculada na radiografia AP usando o método de Lewinnek e, na cross-table, usando o método direto do Woo e Morrey. Resultados A média e o desvio padrão (DP) foram diferentes em ambas as radiografias, sendo 9,7° ± 5,5° no AP, enquanto na cross-table foram 20,6° ± 8,4° (p < 0,001). Considerando nosso objetivo de 10°, as medidas da cross-table foram estatisticamente diferentes dele (p < 0,001), enquanto a medição AP não diferiu (p = 0,716). Conclusão O presente estudo mostrou que a melhor maneira de avaliar corretamente o posicionamento do componente acetabular após uma ATQ é medindo a anteversão e a abdução em uma radiografia AP após confirmar, em uma radiografia cross-table, que o componente não é retrovertido.

Abstract Objective The objective of the present work was to compare the measurement of acetabular component version on anteroposterior (AP) and on cross-table radiographs after total hip arthroplasty (THA). Methods Radiographs of 60 hips with a primary THA were selected. Version was calculated on the AP radiograph using the Lewinnek method and, on the cross-table, using the Woo and Morrey direct method. Results Mean and standard deviation (SD) were different on both radiographs, being 9.7° ± 5.5° on the AP, whereas in the cross-table the measurements were 20.6° ± 8.4° (p < 0.001). Minding our aim of 10°, the cross-table measurements were statistically different from it (p < 0.001), while the AP measurement did not differ (p = 0.716). Conclusion The present study showed that the best way to correctly evaluate the acetabular component positioning following a THA is by measuring anteversion and abduction on an AP radiograph after confirming, in a cross-table radiograph, that the component is not retroverted.

Resumen La endocarditis infecciosa es un proceso patológico de baja incidencia en la clínica diaria; su principal etiología son los agentes bacterianos, los cuales colonizan con mayor prevalencia de válvula mitral y aortica. En este artículo se presenta el estudio de un perro con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna. Se presenta con un soplo de aparición súbita, claudicaciones intermitentes, inapetencia, depresión y fiebre, por lo cual se hace la valoración ecocardiográfica, donde se evidencia engrosamiento valvular mitral, acompañado de estructuras hiperecoicas en el borde libre que corresponden a lesiones vegetativas. Por medio de los criterios de Duke modificados se obtiene un diagnóstico definitivo de endocarditis infecciosa, para lo cual se realiza manejo médico intrahospitalario, sin evolución favorable. Los hallazgos clínicos y paraclínicos coinciden con lo reportado en la literatura. Los criterios de Duke modificados permiten orientar el diagnóstico y evidenciar signos clínicos de alarma. El manejo médico antimicrobiano deberá realizarse con base en hemocultivos y pruebas de sensibilidad, siempre teniendo en cuenta la prevalencia de patógenos y el origen primario de la infección. Se debe considerar como una patología con un pronóstico malo y un porcentaje de fatalidad alto. Finalmente, se concluye que la principal limitación del caso es la falta de confirmación histopatológica.

Abstract Infectious endocarditis is a pathological process with low incidence in the daily clinical practice. The main etiology are the bacterial agents that colonize with higher prevalence the mitral and aortic valves. This paper reports the case of a dog with a previous diagnosis of peripheral vestibular syndrome secondary to probable otitis media-interna. The dog has a sudden heart murmur, intermittent claudications, lack of appetite, depression and temperatures. It is performed an echocardiographic assessment that shows mitral valve thickening with hyperecoic structures in the free border that indicates vegetations. Using the Modified Duke Criteria, a definitive diagnosis of infectious endocarditis is concluded. The dog is provided a medical treatment at the clinic without success. The clinical and paraclinical findings match the background found in the literature. Modified Duke Criteria allow guiding the diagnosis process and uncovering the alarm clinical signs. Antimicrobial clinical treatment must be administered based on blood cultures and sensitivity tests and considering both the pathogen prevalence and infection primary origin. Doctors must deem this condition as a bad prognosis pathology with a high mortality percentage. Finally, it is concluded that the main limitation in this case is a lack of histopathological confirmation.

ABSTRACT Reference intervals (RI) of physiological parameters related to the acid-base equilibrium state were estimated from blood samples of 76 healthy mules at high altitude. The animals were at rest and subjected to the same diet. The data obtained were compared with those reported by various authors, finding closeness between the estimated RIs and those of the cited authors. It was concluded that the RI of mules and horses do not present great differences.

RESUMEN Se estimaron intervalos de referencia (IR) de parámetros fisiológicos relacionados con el estado de equilibrio acido-base a partir de muestras de sangre de 76 de mulas sanas a gran altura. Los animales estuvieron en reposo y sometidos a una misma dieta. Los datos obtenidos fueron comparados con los reportados por varios autores, encontrando cercanía entre los IR estimados y los de los autores citados. Se concluyó que los IR de mulas y caballos no presentan grandes diferencias.