Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation. Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks. Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal. Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days. Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

Background: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS) may be used in acute MCRO. Aim: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance. Methods: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period. Results: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19) and palliation in the remaining 60% (n = 28). The location of the tumor did not influence the presence of lymph node involvement (p = 0.764) nor metastasis (p = 0.885). Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001). Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385), early (p = 0.950) or late complications (p = 0.057). Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%. Conclusions: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance.

Há evidências, tanto da dificuldade de meninos e meninas de rua em conseguir escolarizar-se, como de que valorizam a escola, embora não sejam bem sucedidos nela, o que faz com que se sintam incapazes como aprendizes. O computador pode ser pensado como instrumento mental, com status de bem de consumo valorizado, associado a domínio da tecnologia e sofisticação intelectual, e ser uma via para reintroduzir a aprendizagem formal, de forma não associada a fracassos anteriores. Dez meninos e meninas, atendidos por uma instituição não governamental, participaram de uma oficina nesse sentido. A proposta - de aprender a usar o computador para escrever suas estórias, com a meta de elaborar uma publicação - visou propiciar mudanças sócio-cognitivas e no vínculo com a aprendizagem formal. A experiência parece ter sido bem sucedida em alguns aspectos e é relatada neste trabalho. Experiências como esta podem ser ampliadas e usadas como facilitadoras na reintegração de meninos e meninas de rua em ambientes de aprendizagem formal.

Research findings show that street children have difficulties and are not successful in school, although, at the same time, they value it. This generates feelings of being incapable of learning. Computers can be considered as mental instruments, having a status of a valued consumer good, associated to technological development and intellectual sophistication. For those reasons, they can be used to introduce formal learning again in a way not associated to previous failures. Ten adolescents assisted by a non-governmental organization, participated in a workshop with this aim. It was proposed to them to learn how to use a computer to write and publish their own stories. The objectives were to facilitate socio-cognitive changes and to improve their relationship with formal learning. This workshop seemed to have been successful in some aspects and it is described in this paper. Experiences such as this one can be amplified and used to facilitate reintegration of street children in formal learning environments.

Os machos de Lu. longipalpis ocorrem em duas formas distintas: uma com um simples par de manchas claras no 4º tergito e a outra com um par adicional de manchas caracterizadas no 3º tergito. Cruzamento entre linhagens obtidas no laboratório das duas formas, originárias de áreas alopátricas e simpátricas no Brasil, demonstrou que quase todos os machos falharam em inseminar fêmeas heterólogas. Observou-se também falhas na inseminação entre populações alopátricas de Lu. longipalpis com as mesmas características de manchas indicando a existência de duas ou masi formas num aparente complexo de espécies. A possibilidade de Lu. longipalpis sensu latu representar mais que um simples taxon é discutida e a relevância destes encontros no futuros estudos epidemiológicos do kala-azar é considerada.

The males of the sandfly Lutzomyia longipalpis occur in two forms, one which bears a single pair of pale spots on tergite 4 and another in which an additional pair of spots characterizes tergite 3. In crosses between laboratory reared stocks of the two forms originating from allopatric and sympatric sites in Brazil nearly all males of one form fail to inseminate females of the other. In addition, insemination failure between some allopatric populaytions of Lu. longipalpis with similar tergal spot patterns is recorded, indicating the existence of additional forms in an apparent species complex. The possibility that Lu. longipalpis sensu latu represents more than a single taxon is discussed and the relevance of these findings to future epidemiological studies on kala-azar is considered.