Introdução: O tratamento endovascular de dissecções tipo B tem-se focado na cobertura da porta de entrada. No entanto, recentemente, tem surgido a preocupação em relação ao remodeling distal da aorta e novas técnicas como a Stent-Assisted Balloon-Induced Intimal Disruption and Relamination (STABILISE) tem ganho relevo. Os autores descrevem um nota técnica de uma combinação da técnica de STABILISE com a Covered Reconstruction of the Aortic Bifurcation (CERAB) de forma a obter um remodeling aórtico completo. Métodos: Neste artigo descreve-se uma abordagem sequencial no tratamento endovascular de dissecções da aorta tipo B. O procedimento é iniciado com um TEVAR simples. Se o doente mantém sinais de compressão do verdadeiro lúmen após a abertura da primeira endoprótese a técnica de STABILISE é realizada sempre que possível de forma a obter expansão do verdadeiro lúmen e remodeling aórtico completo. No entanto, em alguns doentes, a perfusão do falso e compressão do verdadeiro lúmen mantêm-se devido a portas de re-entrada distais. Nestes doentes, se existirem sinais de oclusão da aorta infra-renal ou iliaca ou ainda a presença de trombose distal do falso lúmen a ténica de CERAB é realizada em simultâneo. Conclusão:A combinação de ambas as técnicas com o objetivo de cobrir a porta de entrada e as portas de re-entrada distais permite uma união de ambos os flaps, com obliteração completa do falso lúmen, expansão do verdadeiro lúmen e um remodeling aórtico óptimo.

Introduction: Endovascular treatment of type B aortic dissection has focused on the covering of the proximal entry tear. However, recently, concern has emerged regarding the distal aortic remodeling and new techniques such as the Stent-Assisted Balloon-Induced Intimal Disruption and Relamination (STABILISE) technique have gained more acceptance. We describe a technical note regarding the combination of the STABILISE technique in addition to the Covered Reconstruction of the Aortic Bifurcation (CERAB) technique to achieve complete aortic remodeling. Methods: The authors describe a stepwise approach regarding the endovascular repair of type B aortic dissections. A simple TEVAR is performed first. If the patient still shows signs of true lumen compression, a STABILISE technique is performed in order to achieve true lumen expansion and complete aortic remodeling. However, in some patients, false lumen perfusion and true lumen compression at the very distal aorta is maintained due to distal comunicating tears. In these patients, if there are still signs of infra-renal aortic or iliac compression/occlusion or distal thrombosis of the false lumen, a simultaneous CERAB is performed. Conclusion: By combining these techniques, we aim to cover both the proximal tear and the distal comunicating tears resulting in a complete flap apposition, false lumen obliteration, re-expansion of the true lumen and achieve optimal remodeling.

O aumento da disponibilidade de água no solo é importante para o manejo de pomares de laranja não irrigados. O objetivo deste trabalho foi avaliar a água em um Latossolo Vermelho distrófico em sistemas de preparo utilizados para implantação do pomar, manejo da cobertura morta e porta-enxertos em pomar de laranjeira 'Pêra', no noroeste do Paraná. Um experimento no esquema de parcelas subsubdivididas foi implantado em 2002, em área com pastagem de braquiária-brizanta (Brachiaria brizantha), utilizando três sistemas de preparo do solo nas parcelas (sem revolvimento, com revolvimento e em faixas). A gramínea foi roçada duas vezes ao ano nas entrelinhas, constituindo dois tratamentos nas subparcelas (sem e com cobertura morta nas linhas das plantas). Nas subsubparcelas, foram avaliados dois porta-enxertos (limoeiro 'Cravo' e tangerineira 'Cleópatra'). Nas linhas das plantas, avaliou-se o conteúdo de água no solo nas camada de 0-20 cm em 2007 e 0-20 e no de 20-40 cm em 2008-2009. O efeito do preparo do solo no conteúdo de água foi verificado somente em 2007, e o efeito da cobertura morta e dos porta-enxertos, em 2007-2009. O cultivo de laranjeira 'Pêra' enxertada sobre tangerineira 'Cleópatra' reduziu o conteúdo de água do solo em relação ao limoeiro "Cravo". A cobertura morta influenciou positivamente o conteúdo de água na superfície (0-20 cm; textura arenosa) e na subsuperfície do solo (20-40 cm; textura média) durante a primavera. A produção de braquiária-brizanta nas entrelinhas e seu manejo nas linhas das plantas como cobertura morta aumentaram a disponibilidade de água para as laranjeiras.

The increased availability of soil water is important for the management of non-irrigated orange orchards. The objective of this study was to evaluate the availability of soil water in a Haplorthox (Rhodic Ferralsol) under different tillage systems used for orchard plantation, mulch management and rootstocks in a "Pêra" orange orchard in northwest Paraná, Brazil. An experiment in a split-split-plot design was established in 2002, in an area cultivated with Brachiaria brizantha grass in which three tillage systems (no tillage, conventional tillage and strip-tillage) were used for orchard plantation. This grass was mowed twice a year between the rows, representing two mulch managements in the split plots (no mulching and mulching in the plant rows). The split-split-plots were represented by two rootstocks ("Rangpur" lime and "Cleopatra" mandarin). The soil water content in the plant rows was evaluated in the 0-20 cm layer in 2007 and at 0-20 and 20-40 cm in 2008-2009. The effect of soil tillage systems prior to implantation of orange orchards on soil water availability was less pronounced than mulching and the rootstocks. The soil water availability was lower when "Pêra" orange trees were grafted on "Cleopatra" mandarin than on "Rangpur" lime rootstocks. Mulching had a positive influence on soil water availability in the sandy surface layer (0-20 cm) and sandy clay loam subsurface (20-40 cm) of the soil in the spring. The production of B. brizantha between the rows and residue disposal in the plant rows as mulch increased water availability to the "Pêra" orange trees.

OBJETIVO: Analisar o efeito do processo de estigmatização e discriminação no ambiente de trabalho sobre os cuidados cotidianos à saúde e o bem-estar de homens vivendo com HIV/Aids. MÉTODOS: Estudo qualitativo com 17 homens vivendo com HIV, realizado em 2002. Foram estudados os depoimentos em grupo para discutir as dificuldades sobre discriminação no ambiente de trabalho, utilizando análise das práticas discursivas. O grupo, proveniente de centro especializado em HIV/Aids da cidade de São Paulo, representou segmento de pesquisa anterior. RESULTADOS: O debate entre os participantes indicou que o tratamento anti-retroviral exige idas freqüentes aos serviços de assistência médica, que implicam em faltas ou atrasos no trabalho. A apresentação de atestados médicos para justificar ausência no trabalho, mesmo sem indicar Aids, pode resultar em demissão. Desempregados, muitos são barrados nos exames médicos e têm o direito ao sigilo de sua condição violado. Como último recurso, o pedido de aposentadoria implica em cenas de humilhação ou discriminação na perícia médica. CONCLUSÕES: A assistência planejada com o envolvimento dos pacientes consegue ampliar a atenção psicossocial e considerar as necessidades do paciente trabalhador ou desempregado, reconhecendo que o estigma limita o cuidado, afetando a saúde mental e a evolução da infecção. Mitigar o efeito do estigma e da discriminação requer articulação política intersetorial e contribuirá para atingir metas globalmente reconhecidas como fundamentais para o controle da epidemia.

OBJECTIVE: To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. METHODS: Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. RESULTS: The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. CONCLUSIONS: Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.

OBJETIVO: Analisar o efeito do processo de estigmatização e discriminação no ambiente de trabalho sobre os cuidados cotidianos à saúde e o bem-estar de homens vivendo com HIV/Aids. MÉTODOS: Estudo qualitativo com 17 homens vivendo com HIV, realizado em 2002. Foram estudados os depoimentos em grupo para discutir as dificuldades sobre discriminação no ambiente de trabalho, utilizando análise das práticas discursivas. O grupo, proveniente de centro especializado em HIV/Aids da cidade de São Paulo, representou segmento de pesquisa anterior. RESULTADOS: O debate entre os participantes indicou que o tratamento anti-retroviral exige idas freqüentes aos serviços de assistência médica, que implicam em faltas ou atrasos no trabalho. A apresentação de atestados médicos para justificar ausência no trabalho, mesmo sem indicar Aids, pode resultar em demissão. Desempregados, muitos são barrados nos exames médicos e têm o direito ao sigilo de sua condição violado. Como último recurso, o pedido de aposentadoria implica em cenas de humilhação ou discriminação na perícia médica. CONCLUSÕES: A assistência planejada com o envolvimento dos pacientes consegue ampliar a atenção psicossocial e considerar as necessidades do paciente trabalhador ou desempregado, reconhecendo que o estigma limita o cuidado, afetando a saúde mental e a evolução da infecção. Mitigar o efeito do estigma e da discriminação requer articulação política intersetorial e contribuirá para atingir metas globalmente reconhecidas como fundamentais para o controle da epidemia.

OBJECTIVE: To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. METHODS: Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. RESULTS: The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. CONCLUSIONS: Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.

OBJECTIVE: To report the prevalence of antibodies against the hepatitis C virus (anti-HCV) in a group of patients with hepatic cirrhosis (HC). MATERIAL AND METHODS: A prospective transversal and descriptive study was carried out from March 1998 to May 1999. Study subjects were 153 patients; 117 (76%) male and 36 (24%) female, diagnosed with HC. They were attended at the General Hospital Agustín O' Horan and at Regional Research Center Doctor Hideyo Noguchi, in Merida, Yucatan, Mexico. A clinical-epidemiologic questionnaire completed by interview was used for data collection. Anti-HCV were detected using a 2nd generation enzyme-linked immunosorbent assay (ELISA-2). To confirm diagnosis, a second generation recombining immunoblot assay (RIBA-2) was used. Hepatitis B surface antigen (HbsAg) and antibodies against the hepatitis B core antigen (anti-HBc) were determined using ELISA. The presence of anti-HCV was related to the epidemiologic variables of study subjects. The prevalence of anti-HCV was obtained and the frequency of the characteristics obtained by interview were compared among the positive and negative patients through the c² test and the Fisher's exact test, as needed. RESULTS: Among patients with HC (35/117 (30%) male and 14/36 (39%) female), 32 % were positive to anti-HCV. Alcoholism was present in all seroreactive males and absent in all positive females (p< 0.001). Data obtained through an interview were not associated with seropositivity. Anti-HBc was found in 16% of patients positive to anti-HCV and in 12% of seronegatives (p=0.69). CONCLUSIONS: The prevalence found was greater than previous reports in the general population in the Yucatan Peninsula (1.3%). The high prevalence of anti-HCV in these patients suggests that HC is more frequently associated with HCV in Yucatan, Mexico than hepatitis B. Alcoholism probably acts as a co-factor for the development of HC in males.

OBJETIVO: En este estudio reportamos la prevalencia de anticuerpos contra el virus C de la hepatitis (Ac-VCH) en un grupo de pacientes con cirrosis hepática (CH). MATERIAL Y MÉTODOS: Se hizo un estudio prospectivo, transversal y descriptivo, de marzo de 1998 a mayo de 1999. Se estudiaron a 153 pacientes (117 (76%) hombres y 36 (24%) mujeres) con diagnóstico de CH, que eran atendidos en el Hospital General Agustín O' Horan y en el Centro de Investigaciones Regionales Doctor Hideyo Noguchi, en la ciudad de Mérida, Yucatán, México. Se aplicó un cuestionario con datos clínico-epidemiológicos y se determinó la presencia de Ac-VCH (ELISA de 2ª generación y RIBA-2 para confirmar el diagnóstico) a cada paciente. Se determinó también el antígeno de superficie de la hepatitis B (AgsHB) y anticuerpos contra el antígeno central de la hepatitis B (Anti-HBc) mediante el método de ELISA. La presencia de Ac-VCH fue relacionada con las variables epidemiológicas de los sujetos. La prevalencia de anti-HCV y la frecuencia de características se compararon entre los pacientes positivos y negativos con las pruebas de c² y exacta de Fisher. RESULTADOS: El 32% de los pacientes con CH (35/117 (30%) hombres y 14/36 (39%) mujeres) fueron positivos para los Ac-VCH. El alcoholismo estuvo presente en todos los hombres serorreactivos y en ninguna de las mujeres positivas (p< 0.001). Ninguna de las variables epidemiológicas analizadas estuvo asociada con la seropositividad. Los anti-HBc se encontraron en 16% de los pacientes positivos para Ac-VCH y en 12% de los seronegativos (p=0.69). CONCLUSIONES: La prevalencia encontrada fue mayor a los reportes previos realizados en población general de la Península de Yucatán (1.3%). La alta prevalencia de Ac-VCH en este grupo de pacientes sugiere que la CH está más frecuentemente asociada con el VCH en Yucatán, México, que con el virus B de la hepatitis. El alcoholismo probablemente actúa como un cofactor en el desarrollo de CH en los hombres.

OBJECTIVE: To report the prevalence of antibodies against the hepatitis C virus (anti-HCV) in a group of patients with hepatic cirrhosis (HC). MATERIAL AND METHODS: A prospective transversal and descriptive study was carried out from March 1998 to May 1999. Study subjects were 153 patients; 117 (76%) male and 36 (24%) female, diagnosed with HC. They were attended at the General Hospital Agustín O' Horan and at Regional Research Center Doctor Hideyo Noguchi, in Merida, Yucatan, Mexico. A clinical-epidemiologic questionnaire completed by interview was used for data collection. Anti-HCV were detected using a 2nd generation enzyme-linked immunosorbent assay (ELISA-2). To confirm diagnosis, a second generation recombining immunoblot assay (RIBA-2) was used. Hepatitis B surface antigen (HbsAg) and antibodies against the hepatitis B core antigen (anti-HBc) were determined using ELISA. The presence of anti-HCV was related to the epidemiologic variables of study subjects. The prevalence of anti-HCV was obtained and the frequency of the characteristics obtained by interview were compared among the positive and negative patients through the c² test and the Fisher's exact test, as needed. RESULTS: Among patients with HC (35/117 (30%) male and 14/36 (39%) female), 32 % were positive to anti-HCV. Alcoholism was present in all seroreactive males and absent in all positive females (p< 0.001). Data obtained through an interview were not associated with seropositivity. Anti-HBc was found in 16% of patients positive to anti-HCV and in 12% of seronegatives (p=0.69). CONCLUSIONS: The prevalence found was greater than previous reports in the general population in the Yucatan Peninsula (1.3%). The high prevalence of anti-HCV in these patients suggests that HC is more frequently associated with HCV in Yucatan, Mexico than hepatitis B. Alcoholism probably acts as a co-factor for the development of HC in males.

OBJETIVO: En este estudio reportamos la prevalencia de anticuerpos contra el virus C de la hepatitis (Ac-VCH) en un grupo de pacientes con cirrosis hepática (CH). MATERIAL Y MÉTODOS: Se hizo un estudio prospectivo, transversal y descriptivo, de marzo de 1998 a mayo de 1999. Se estudiaron a 153 pacientes (117 (76%) hombres y 36 (24%) mujeres) con diagnóstico de CH, que eran atendidos en el Hospital General Agustín O' Horan y en el Centro de Investigaciones Regionales Doctor Hideyo Noguchi, en la ciudad de Mérida, Yucatán, México. Se aplicó un cuestionario con datos clínico-epidemiológicos y se determinó la presencia de Ac-VCH (ELISA de 2ª generación y RIBA-2 para confirmar el diagnóstico) a cada paciente. Se determinó también el antígeno de superficie de la hepatitis B (AgsHB) y anticuerpos contra el antígeno central de la hepatitis B (Anti-HBc) mediante el método de ELISA. La presencia de Ac-VCH fue relacionada con las variables epidemiológicas de los sujetos. La prevalencia de anti-HCV y la frecuencia de características se compararon entre los pacientes positivos y negativos con las pruebas de c² y exacta de Fisher. RESULTADOS: El 32% de los pacientes con CH (35/117 (30%) hombres y 14/36 (39%) mujeres) fueron positivos para los Ac-VCH. El alcoholismo estuvo presente en todos los hombres serorreactivos y en ninguna de las mujeres positivas (p< 0.001). Ninguna de las variables epidemiológicas analizadas estuvo asociada con la seropositividad. Los anti-HBc se encontraron en 16% de los pacientes positivos para Ac-VCH y en 12% de los seronegativos (p=0.69). CONCLUSIONES: La prevalencia encontrada fue mayor a los reportes previos realizados en población general de la Península de Yucatán (1.3%). La alta prevalencia de Ac-VCH en este grupo de pacientes sugiere que la CH está más frecuentemente asociada con el VCH en Yucatán, México, que con el virus B de la hepatitis. El alcoholismo probablemente actúa como un cofactor en el desarrollo de CH en los hombres.