ABSTRACT Purpose: Surgery for renal cell carcinoma (RCC) with an inferior vena cava (IVC) tumor thrombus can be done via a robotic approach. While this approach is thought to minimize blood loss, it may still result in significant losses (1) and current publications indicate that it can require upwards of 3-day hospital stays (1, 2). However, innovative surgical techniques, such as the split and roll, may curtail this. The purpose of this video is to present the case and surgical technique of robotic assisted radical nephrectomy with IVC thrombectomy. Materials and Methods: The patient was a 77-year-old male found to have a right upper pole renal mass on CT urogram. On MRI (Figure 1), a renal mass and level II thrombus was seen. For this case, the Da Vinci Xi Intuitive robotic system was used, with four robotic 8-millimeter (mm) metallic trocars, two 5 mm assistant trocars, and one 12 mm air seal port. The split and roll technique were utilized to access the IVC and lumbar veins. This surgical method uses the adventitia of the IVC as a plane of dissection and safely identifies all branches/tributaries of the IVC to minimize the chance of vascular injury (3). Results: Robotic console time was 150 minutes. The patient had an excellent outcome, with all tumor thrombus removed, less than 50cc of blood loss, and was discharged within 24 hours of the operation. The tumor pathology came back as papillary, high grade, and was stage pT3bN1. Conclusions: The robotic approach with split and roll technique is a great surgical option for urologists to consider in patients with RCC and a level I or II thrombus, which can minimize blood loss and expedite discharge.

ABSTRACT Introduction: People who are part of the armed forces worldwide have been susceptible to the development of post-traumatic stress disorder, due to exposure to conditions that predispose its development. Objective: To establish the frequency and possible associated risk factors of post-traumatic stress disorder in subjects with chest injuries, suffered in combat. Methods: Comparative study between subjects with chest trauma suffered in combat and military without thoracic injury with experience in combat, by evaluating a 24-question diagnostic questionnaire, validated for Colombia, of post-traumatic stress disorder. Military population older than 18 years and younger than 55 years, with chest trauma who underwent medical or surgical management (thoracotomy or laparotomy) were included. Results: 45 subjects entered the study, 25 with a history of chest trauma and 20 healthy with combat experience. Of the trauma subjects, 25 were evaluated at 3 months and 11 at 5 months. In the subjects wounded in combat, the average age was 24,1 years (SD: 4,99). At the 3-month evaluation, 36 % (p = 0,025) of the subjects with a history of chest trauma met the diagnostic criteria for post-traumatic stress disorder, which shows an increase of 9,5 % at the 6-month follow-up. Conclusion: There is a higher frequency of post-traumatic stress disorder in subjects exposed to traumatic chest events in areas of armed conflict. Young age and low educational levels could be factors associated with the appearance of the disorder.

RESUMEN Introducción: Las personas que forman parte de las fuerzas armadas a nivel mundial han sido susceptibles al desarrollo del trastorno de estrés postraumático, debido a la exposición a condiciones que predisponen su desarrollo. Objetivo: Establecer la frecuencia y posibles factores de riesgo asociados del trastorno de estrés postraumático en sujetos con lesiones en tórax, sufridas en combate. Métodos: Estudio comparativo entre sujetos con trauma de tórax sufrido en combate y militares sin lesión torácica con experiencia en combate, mediante la evaluación de un cuestionario diagnóstico de 24 preguntas, validado para Colombia del trastorno de estrés postraumático. Se incluyó población militar de mayores de 18 años y menores de 55 años, con trauma de tórax que tuvieron manejo médico o quirúrgico (toracotomía o laparotomía). Resultados: Ingresaron al estudio 45 sujetos, 25 con antecedente de trauma de tórax y 20 sanos con experiencia en combate. De los sujetos con trauma, 25 se evaluaron a los 3 meses y 11 a los 5 meses. En los sujetos heridos en combate el promedio de edad fue de 24,1 años (DE: 4,99). A los 3 meses de valoración, el 36 % (p= 0,025) de los sujetos con antecedente de trauma de tórax cumplían criterios diagnósticos de trastorno de estrés postraumático, lo cual evidencia un aumento del 9,5 % a los 6 meses de seguimiento. Conclusión: Existe mayor frecuencia del trastorno de estrés postraumático en sujetos expuestos a eventos traumáticos de tórax en áreas de conflictos armados. La corta edad y los bajos niveles educativos podrían ser factores asociados a la aparición del trastorno.

Abstract A study was conducted to evaluate the effect of foot-and-mouth disease (FMD) virus vaccination, applied during the embryonic period, on pregnancy loss of Angus cows pregnant by fixed-time artificial insemination (FTAI). Thirty-two days after FTAI pregnancy diagnosis was carried out. Two hundred ninety three pregnant cattle (heifers, n = 108, primiparous cows, n = 88 and multiparous cows, n = 97) were randomly assigned to one of two treatments: FMD vaccinated (VAC, n = 147) at 32 days after FTAI, and without vaccinating (NOVAC, n = 146). Sixty days after FTAI pregnancy diagnosis was carried out in order to quantify pregnancy losses. No significant differences (P = 0.78) in the percentage of pregnancy losses between 32 and 60 days after fixed-time AI between VAC (4.76%) and NOVAC (5.48%) were observed. Under the conditions of the present study, the application of FMD vaccination at 32 days of gestation had no effect on pregnancy loss in Angus cattle.

Resumen Se realizó un estudio para evaluar el efecto de la vacunación contra el virus de la fiebre aftosa (FA), aplicada durante el periodo embrionario, sobre la pérdida de preñez en un rodeo de vacas Angus que habían sido inseminadas artificialmente a tiempo fijo (IATF). Treinta y dos días post IATF se realizó el diagnóstico de gestación. Doscientas noventa y tres hembras preñadas (vaquillonas, n = 108, vacas primíparas, n = 88 y vacas multíparas, n = 97) fueron asignadas al azar a uno de dos tratamientos: vacunadas (VAC; n = 147) contra el virus de FA a los 32 días post IATF, y sin vacunar (NOVAC; n = 146). Sesenta días post IATF se realizó un segundo diagnóstico de gestación y se cuantificó la pérdida de preñez. No se observaron diferencias significativas (P = 0,78) en el porcentaje de pérdida de preñez entre los 32 y 60 días post IATF entre VAC (4,76%) y NOVAC (5,48%). Bajo las condiciones del presente estudio, la aplicación de la vacuna contra el virus de la FA a los 32 días de gestación no tuvo efecto en la pérdida de preñez en bovinos Angus.

ABSTRACT Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID-19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID-19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID-19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.

RESUMEN Lippia alba (Mill.) N.E.Br. (hierba de limón) es una especie de interés medicinal y aromática, con estudios incipientes en relación a la nutrición mineral y a la luminosidad en las respuestas foliares y vegetativas. El objetivo del trabajo fue evaluar los aspectos foliares y la producción de plántulas de L. alba bajo dos condiciones de luminosidad (pleno sol y 50% de sombreamiento) y cuatro niveles de fósforo (0, 150, 300 y 450 mg kg-1). Las plántulas presentaron alteraciones en los índices fisiológicos y respuestas fotoquímicas basadas en la fluorescencia de la clorofila-a. La fertilización fosfatada contribuyó en la mitigación del estrés luminoso en la síntesis de clorofilas. La mayor pro ducción de biomasa de las hojas ocurrió con la adición de P. El análisis de componentes principales explicó el 74% de la variabilidad donde fueron características representativas el número de hojas, la fluorescencia inicial y el área foliar específica dentro del componente principal 1 (PC 1) y el número de brotes, supervivencia y el área foliar en el PC 2. En el análisis de conglomerados, se constató la formación de dos grupos, con distancias más bajas entre 300 pleno sol y 450 sombreamiento (2.31). Las plántulas cultivadas a pleno sol presentaron mayor capacidad de supervivencia y calidad. La producción de plántulas de L. alba debe ser realizada bajo pleno sol con adición de 450 mg kg-1 del fósforo.

ABSTRACT Lippia alba (Mill.) N.E.Br. (lemongrass) is a spice and medicinal plant species, with fledgling studies related to mineral nutrition and luminosity on foliar and vegetative responses. Thus, the aim of this study was to assess the foliar aspects and production of L. alba under two light conditions (full sun and 50% shading) and four levels of phosphorus-P (0, 150, 300 and 450 mg kg-1). The L. alba seedlings presented changes in physiological indices and photochemical responses based on chlorophyll-a fluorescence. The phosphate fertilization helped mitigate the light stress for the synthesis of chlorophylls. The greatest leaf biomass production occurred with addition of P. The principal components analysis explained 74% of the variability, with leaf number, initial fluorescence and specific leaf area in principal component 1 (PC 1) and bud number, survival and leaf area in PC 2. Two groups formed in the cluster analysis, with lower distances between P300 full sun and P450 sha ding (2.31). The seedlings cultivated under full sun presented a higher survivability and seedling quality. The production of L. alba seedlings should be done under full sun with the addition of 450 mg kg-1 of phosphorus.

ABSTRACT Notably, basic education institutions in Brazil, as well as other educational institutions, have faced constant challenges brought about by changes in the organizational environment. Thus, the objective of this work was to study the Strategic Management of Knowledge as an instrument of value in a private institution of basic education. The research developed was qualitative. The universe of the study was constituted by a basic school of the city of Campina Grande in the state of Paraíba. The approach developed in this work was qualitative and the approach used was exploratory-descriptive. For the data collection a semi-structured interview with the collaborators and field observations was carried out. The results found in the research highlighted the need for valuation in the subjectivity of people in the organizational context. According to these results, the concept of the individual emerged as an organizational collaborator, where the product of the collaborator's attitudes is the fruit of his cognitive processes, such as: intelligence, competence, experience, capacity, motivation, socialization, leadership among other cognitive factors that are emerging in their organizational daily life. By our observations and conclusions, the behavior of the collaborator, as an active agent of the organization causes both (employee and organization) to gain in terms of intrinsic benefits.

RESUMO Notadamente, as instituições de ensino básico no Brasil, assim como outras instituições educacionais, têm enfrentado constantes desafios provocados por mudanças no ambiente organizacional. Desse modo, o objetivo deste trabalho foi estudar a Gestão Estratégica do Conhecimento como instrumento de valor em uma instituição privada de ensino básico. A pesquisa desenvolvida foi qualitativa. O universo do estudo foi constituído por uma escola de ensino básico da cidade de Campina Grande no estado da Paraíba. A abordagem desenvolvida nesse trabalho foi qualitativa e o enfoque utilizado foi exploratório-descritivo. Para a coleta de dados foi realizada uma entrevista semi-estruturada com os colaboradores e observações de campo. Os resultados encontrados na pesquisa destacaram a necessidade de valorização na subjetividade das pessoas no contexto organizacional. Conforme tais resultados, tornou-se emergente o conceito do indivíduo como colaborador organizacional, onde o produto das atitudes do colaborador é fruto dos seus processos cognitivos, tais como: inteligência, competência, experiência, capacidade, motivação, socialização, liderança entre outros fatores cognitivos que vão surgindo no seu cotidiano organizacional. Pelas nossas observações e conclusões, o comportamento do colaborador, enquanto um agente ativo da organização faz com que ambos (colaborador e organização) saiam ganhando em termos de benefícios intrínsecos.

Antecedentes: La cafeína es el estimulante del sistema nervioso más consumido a nivel mundial. Aunque, la cafeína tiene diferentes efectos sobre las funciones cerebrales, poco se sabe acerca de su farmacocinética en el cerebro. Por ejemplo, la mayoría de estudios que evaluaron la distribución de cafeína en el cerebro de rata han medido niveles de cafeína en corteza y estriado, pero no en áreas cerebrales más específicas. Objetivo: El propósito del trabajo fue medir la concentración de cafeína en sangre y diferentes regiones encefálicas (corteza, estriado, hipocampo, cerebelo, tallo cerebral), a diferentes tiempos, después de administrar una única dosis de cafeína. Método: Ratas Wistar adultas (250-300 gr) recibieron una dosis intraperitoneal de cafeína de 30mg/Kg de peso. 20, 40 60 y 80 minutos después de la administración, los sujetos se sacrificaron por decapitación y se obtuvieron muestras de plasma, corteza cerebral, estriado, hipocampo, cerebelo y tallo cerebral. Los niveles de cafeína en plasma y estructuras encefálicas se determinaron por RP-HPLC y se realizó análisis estadístico. Resultados: Los niveles de cafeína fueron mayores en plasma que en las regiones encefálicas estudiadas. Las distintas regiones encefálicas presentaron concentraciones similares de cafeína. En todas las regiones, la mayor concentración de cafeína se obtuvo 40 minutos después de la administración de cafeína. Conclusiones: Este estudio soporta resultados previos que muestran concentraciones similares de cafeína entre la corteza y el estriado, además los extiende a otras regiones encefálicas. La concentración de cafeína aumenta similarmente en plasma y estructuras encefálicas. 40, 60 y 80 minutos después de la administración, la concentración de cafeína en plasma es casi el doble de la encontrada en el cerebro. Lo anterior sugiere que los efectos de la cafeína en distintas funciones cerebrales no dependen de diferencias farmacocinéticas entre regiones encefálicas sino que son más bien explicadas por factores farmacodinámicos.

Caffeine is a highly consumed stimulant of the nervous system. Although caffeine has diverse effects on different brain functions, little is known about the specific pharmacokinetics of this substance in the brain. For instance, most studies that assessed caffeine distribution in the rat brain have only measured caffeine levels in the cortex and striatum but not in more specific brain areas. Aims: The purpose of this work was to measure the caffeine concentration in blood and different brain regions (i.e. cortex, striatum, hippocampus, cerebellum and brainstem) at different times after the administration of a single intraperitoneal dose of caffeine. Methods: Adult Wistar rats (250 to 300 gr) were injected with a single intraperitoneal dose of 30 mg/Kg of caffeine. 20, 40, 60 and 80 minutes after administration, subjects were sacrificed by decapitation and samples of plasma, cerebral cortex, striatum, hippocampus, cerebellum and brainstem were obtained. Caffeine levels in the blood and each brain structure were measured by RP-HPLC and statistical analysis was performed. Results: Caffeine levels were higher in the plasma compared to all the brain structures studied. Different brain regions displayed similar caffeine concentrations. For all brain regions, the maximal concentration levels of caffeine were reached in the first 40 minutes after caffeine administration. Conclusions: The results support previous studies that show similar caffeine concentration between cortex and striatum, but also extend the results to other brain structures. Furthermore, caffeine concentration increases similarly in the plasma and brain structures. 40, 60 and 80 minutes after administration, caffeine concentration in the blood is almost two times higher than in the brain. This suggests that the effects of caffeine on different brain functions do not depend on pharmacokinetic differences between brain areas and are rather explained by pharmacodynamics.

Introduction: Basketball is a sport with a high heterogeneity anthropometric as playing position. Point guard is usually the lowest player but also the fastest. Guard is similar to point guard, faster and more agile than the others. Small forward has an intermediate height between the inside and outside players and it combines height with velocity. And center (pivot) has a physical role, it has the highest and more muscle mass. The aim of this study is to describe the kinanthropometric profile of male cadet "Valencia Basket Club". Material and Methods: A total of 20 male cadet basketball players were evaluated (15.35±0.59 years old). An anthropometrist level 1 took anthropometric measures according to the methodology of the International Society for the Advancement of Kinanthropometry (ISAK). Body composition was calculated according to the kinanthropometry consensus of the Kinanthropometry Spanish Group (GREC), somatotype with Heath-Carter's method and adiposemuscular and cardiovascular risk index. Results: Differences in values of weight, height, skinfold and body composition from variables of sample and position were observed. Lower values were from point guard position and higher values were from center position. An increasing trend of these parameters was established in the following order: point guard, guard, small forward and center. Conclusions: The Valencia Basket Club cadet player overall somatotype is balance ectomorph. To know kinanthropometric profile may be beneficial to develop specific training and nutrition plans as well as to see evolution and characteristics for optimal performance.

Introducción: El baloncesto presenta una gran heterogeneidad antropométrica entre jugadores en relación a la posición de juego. El base suele ser el más bajo del equipo pero también el más rápido. El escolta suele ser similar al base, más bajo, rápido y ágil que el resto. El alero es de una altura intermedia entre los jugadores interiores y exteriores, combina la altura con la velocidad, y el pívot tiene un rol más físico, es el más alto y con mayor masa muscular. El objetivo del estudio es describir el perfil cineantropométrico del equipo cadete masculino del Valencia Basket Club. Material y Métodos: Se han evaluado 20 jugadores de baloncesto cadete masculino (15,35±0,59años). Un antropometrista nivel I tomó las medidas según la metodología de la Society for the Advancement of Kinanthropometry (ISAK). Se calculó la composición corporal según el consenso de cineantropometría del Grupo Español de Cineantropometría (GREC), el somatotipo según Heath-Carter, e índices adiposo-musculares. Resultados: Se observaron diferencias en los valores de peso, talla, pliegues cutáneos y composición corporal, de las variables estudiadas de la muestra total y por posición de juego, siendo los valores menores los de la posición base y mayores en los pívots. Se estableció una tendencia creciente de estos parámetros en el siguiente orden: base, escolta, alero y pívot. Conclusiones: El somatotipo global del jugador de baloncesto cadete del Valencia Basket Club es ectomorfo balanceado. Conocer el perfil cineantropométrico puede beneficiar la elaboración de planes de entrenamiento y nutrición, así como reflejar la evolución y dirigirla hacia las características ligadas al rendimiento óptimo.

Vascular rings which can cause symptoms related the trachea and esophagus compression occur in less than 1% of all cardiovascular malformations. Double incomplete aortic arch with right-sided aorta and aberrant left subclavian artery is the rarest one, and its present in 0.04-0.1% of autopsy series. A case of this malformation with a Kommerell's Diverticulum is presented. This diverticulum has risk of severe complications such as dissection and/or rupture.

Los anillos vasculares pueden causar síntomas relacionados a compresión de tráquea y esófago y ocurren en menos del 1% de todas las malformaciones cardiovasculares. El doble arco aórtico incompleto con arco aórtico a la derecha y arteria subclavia izquierda aberrante es la forma más rara y se presenta en el 0.04 a 0.1% de las series de autopsia. Se presenta un caso de esta malformación con un divertículo de Kommerell. El divertículo tiene riesgo de complicaciones severas como disección y/o ruptura.

Introduction: Endurance exercises have a direct influence on aerobic capacity. To improve this quality is necessary develop an extensive and continuous training sessions. However anaerobic exercise requires low volume of training and high intensity to sport performance. In aerobic or anaerobic exercise is obvious to state that weight reduction must be performed from the body fat component, furthermore is an important point of view from the last years. Therefore, it is of vital importance to control the strategies used by the athletes in order to obtain the correct weight and avoid eating disorders. Objective: identify differences comparing for groups that develop aerobic or anaerobic exercises, and concerns related to eating disorders, dietetic habits and physical activity. Method: 206 trained men were examined and participated in the study, that can be screened using the validated EAT-26 questionnaire, Predimed fat-free diet questionnaire and Spanish short version of the Minessota Leisure Time Physical Activity questionnaire. Results: Athletes who practice aerobic physical activity showed higher values at majority of EAT-26 scales and total score. When this population increased their training sessions presented higher scores of Oral Control. The effects of consuming supplementation increases EAT-26 scores and eating disorder predisposition. In addition, high-structured training session increases EAT-26 scores and eating disorder predisposition too. Discussion: Practice aerobic physical activities seem to show a greater predisposition to the presence of TCA in athletes.

Introducción: Actividades físicas de larga duración, con predominio aeróbico, requieren una práctica deportiva extensiva y continuada para obtener mejoras en el rendimiento. Mientras que las actividades anaeróbicas, requieren de un volumen de entrenamiento menor, aunque a intensidades más elevadas para alcanzar un buen estado de forma deportiva. La disminución del porcentaje graso dentro de la composición corporal, tanto de deportes aeróbicos como anaeróbicos, es una cuestión presente, sobretodo en estos último tiempos. Conseguir un adecuado estado nutricional, con estrategias inadecuadas, puede originar la aparición de trastornos de la conducta alimentaria. Objetivo: determinar las diferencias existentes entre dos grupos de deportistas en función de la práctica de deportes aeróbicos o anaeróbicos, en cuanto a la presencia de desórdenes alimentarios, adherencia a dieta baja en grasa y actividad física. Método: En este estudio participaron 206 sujetos varones entrenados que cumplimentaron los cuestionarios de actividad física en el tiempo libre de Minnesota abreviado, EAT-26 y Predimed de "Adherencia a dieta baja en grasa". Resultados: Los deportistas que practican deportes aeróbicos muestran mayores puntuaciones en la mayoría de las subescalas y en el resultado total del cuestionario EAT-26. A mayor número de sesiones de práctica en deportes aeróbicos, aparecen puntuaciones superiores en el Control Oral. Dentro de esta población, el consumo de suplementos incrementa significativamente las puntuaciones del EAT-26 y la predisposición a un TCA, al igual que los planes de entrenamientos muy estrictos. Discusión: Los deportistas que practican deportes de corte más aeróbico parecen mostrar una mayor predisposición a la presencia de un TCA.

Introduction: Racket sports require athletes to constantly improve and progress in their physical qualities in order to maintain competitive standards. This includes achieving and maintaining an optimal body composition. However, few studies have been published addressing this topic. Objective: This study tries to provide a complete anthropometric profile, including somatotype and body composition, of paddle and tennis male adult players. Methods: Anthropometric parameters including weight, height, skinfolds, girths and breadths were measured in 21 paddle and 26 tennis players, and the results were compared between the two groups as well as a control group, who did not play racket-based sports. Results: No significant differences in any body composition variable were found comparing tennis vs paddle players, with both groups showing a meso-endomorphic somatotype. The athletes presented lower muscle mass, and therefore less mesomorphic component, compared to the control group. Conclusion: Since body composition is a major determinant in racket sport performance, it is instrumental to control fat and muscle body mass by using adequate dietetic and nutritional tools as well as optimal training programs.

Introducción: los deportistas que practican disciplinas deportivas de raqueta necesitan mejorar constantemente sus cualidades físicas con el fin de competir al máximo nivel. Por lo tanto, es necesario conseguir y mantener en dichos jugadores una óptima composición corporal, pero no obstante, existen pocos estudios publicados relacionados con esta temática. Objetivo: el presente trabajo trata de ofrecer un perfil antropométrico completo, incluyendo el somatotipo y la composición corporal de jugadores varones adultos de pádel y tenis. Material y métodos: se realizaron diversas medidas antropométricas, incluyendo peso corporal total, estatura, pliegues cutáneos, perímetros y diámetros, en 21 jugadores de pádel y 26 jugadores de tenis. Los resultados obtenidos de cada grupo de jugadores se compararon entre ellos y frente a un grupo control que no practicaba deportes de raqueta. Resultados: no se encontraron diferencias significativas en cuanto a las variables de composición corporal analizadas entre los grupos de jugadores de pádel y tenis, mostrando ambos grupos un somatotipo meso-endomófico. Los jugadores presentaron una menor masa muscular, y por tanto un menor componente mesomórfico, cuando se compararon con el grupo control. Conclusión: ya que la composición corporal es determinante en el rendimiento de los jugadores de deportes de raqueta, es imprescindible realizar un control de la grasa y masa muscular mediante herramientas dietético-nutricionales así como de programas de entrenamiento adecuados.

Background The surgical management of patients with symptomatic metastatic or locally advanced recurrences involving the penis remains poorly characterized. The aim of the present abstract and video is to detail our experience in the surgical management of a specific patient with a locally advanced symptomatic recurrence of penile sarcoma secondary to prostate cancer treated with primary brachytherapy. Materials and Methods A 70 year old male patient initially treated for localized prostate cancer with interstitial brachytherapy at an outside facility developed an unfortunate secondary malignancy consisting of a locally advanced penile sarcoma involving as well the prostate and base of the bladder. Despite our best efforts to control his pain, he developed a very symptomatic local recurrence with a secondary penile abscess and purulent periurethral drainage. At this time, it was felt a surgical resection consisting of a total penectomy, urethrectomy, cystoprostatectomy, and ileal conduit urinary diversion would be the best option for local cancer control in this particular patient. Results The patient underwent the surgical resection without any complications as illustrated in this surgical video, with a jejunal intestinal mass identified at the time of surgery which was resected with a primary bowel anastomosis performed. The patient was discharged from hospital uneventfully with his symptomatic local recurrence being successfully managed and the patient no longer requiring oral narcotics for pain control. The pathological report confirmed a locally advanced sarcoma involving the penile, prostate, and bladder which was resected with negative surgical margins and the jejunal mass was confirmed to represent a small bowel sarcoma metastatic site. Conclusion As highlighted in the present video, the treatment of a symptomatic sarcoma local recurrence contiguously involving the penis can be successfully managed provided the patient is informed of the potential morbidity and psychosocial implications imparted by performing a total penectomy and adjacent organ resection.

Introduction. Incidental findings of vascular anatomic variants on computed tomography scans (CT) may cause confusion, misdiagnosis and lead to even more invasive complementary exams. The knowledge of these variants is also important because they can be associated with other anomalies such as heart diseases or polysplenia, and symptoms like dysphagia or dyspnea. Purpose. The aim of this study is to describe the vascular anatomical variants incidentally found on computed tomography imaging. Materials and Methods. A total of 3586 scans were performed between June 2010 and June 2011 with 16-row and a 64-row Multidetector CT scanners. Findings included: right aortic arch, aberrant right subclavian artery, aberrant left subclavian vein, left superior vena cava, left inferior vena cava, double inferior vena cava, circumaortic renal vein, retroaortic left renal vein, subhepatic vein and azygous continuation of the inferior vena cava. Conclusion. Vascular anatomical variants are found with relative frequency on CT scans requested for other reasons. To be familiar with these anomalies may prevent confusions, diagnostic errors and unnecessary complementary exams and forces us to search for other associated anomalies.

Introducción. El hallazgo de variantes anatómicas vasculares en estudios de tomografía computada (TC) puede generar confusiones, diagnósticos incorrectos e incluso la solicitud de nuevos estudios complementarios más invasivos. El conocimiento de estas variantes, además, es importante porque pueden estar asociadas a otras anomalías, como cardiopatías, poliesplenia o síntomas como disfagia o disnea. Objetivo. El objetivo de esta publicación es describir las variantes anatómicas vasculares halladas incidentalmente en estudios de tomografía computada. Materiales y Métodos. Se revisaron 3586 estudios, realizados desde junio de 2010 hasta junio de 2011, con tomografía computada multicorte de 16 y 64 detectores. Entre los estudios analizados, se encontraron: arco aórtico derecho (AAD), subclavia derecha aberrante, vena cava superior izquierda, vena subclavia izquierda aberrante, vena cava inferior (VCI) izquierda, vena renal izquierda doble, vena cava inferior doble, vena renal circumaórtica, vena renal izquierda retroaórtica, vena subhepática e interrupción de la vena cava inferior con continuación en ácigos/hemiácigos. Conclusión. Las variantes anatómicas vasculares son hallazgos que se encuentran con relativa frecuencia en forma incidental en estudios solicitados por otras razones. Su conocimiento puede evitar confusiones y la realización de estudios complementarios innecesarios, así como también nos obliga a analizar la presencia de otras anomalías que podrían estar asociadas.