ABSTRACT Introduction: Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (1) until more definitive alternatives can be proposed. We describe in this video how we approach patients that underwent vesicostomy and want it to be converted into a continent catheterizable reservoir. Material and methods: We perform an infra-umbilical longitudinal incision with a semicircular flap where the stoma will be placed (outside vesicostomy). After releasing the bladder, we proceed with usual steps of the Macedo-Pouch technique (2). We perform the reservoir from 35cm of ileum that constructs a catheterizable channel from the same bowel segment from a 3cm width flap from anterior and posterior wall of ileum in the mid part of it. The continence mechanism of the efferent tube is based on angulation and a serous lined tunnel created with 3-4 3.0 prolene sutures. The stoma is placed in the midline (3). Results: Patient had an uneventful evolution and is continent performing CIC every 4 hours with 9 months of follow-up. We have in the last 3 years a consecutive series of 12 patients operated according to this principle. Discussion: Vesicostomy should be regarded as an alternative for patients with neurogenic bladder refractory to clinical treatment at a younger age in order to postpone definitive treatment such as any an enterocystoplasty. This option must be considered as transient, since definitive reconstructive surgery can provide preservation of renal function and continence achievement. In this context, our video demonstrates that performing a bladder augmentation on a patient with a vesicostomy is safe and feasible. We reinforce that our method precludes the need of appendix or creation of a Monti tube as the outlet channel and the whole procedure is performed from a single piece of bowel.

ABSTRACT The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy. Once the bladder receives part of the radiation, a typical inflammatory condition that configures radiation-induced cystitis may develop. Chronic radiation-induced cystitis is commonly characterized by the bladder new submucosal vascularization, which is typically fragile and favors hematuria. The current study aims to investigate if Hypoxia-Induced Factor (HIF-1α) and its transcriptional target Vascular Endothelial Growth Factor A (VEGF-A) could be a primary pathway leading to increased submucosal vascularization. HIF-1α and VEGF-A mRNA levels in bladder core biopsies from CC patients treated with radiotherapy versus untreated (non-irradiated) patients were analyzed using a droplet digital polymerase chain reaction technology. Gene expression results showed that HIF-1α and VEGF-A had no significant differences between bladder samples from patients previously irradiated and untreated patient samples. However, a direct relationship between the degree of late morbidity and the expression of HIF-1α and VEGF-A has been demonstrated. Despite the lack of statistical significance precludes a definitive conclusion, the data presented herein suggests that further studies investigating the role of HIF-1α in bladder neovascularization in radiation-induced cystitis are highly recommended.

ABSTRACT Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and Methods A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. Discussion The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli’ s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape. Conclusion We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.

Resumo Esta pesquisa tem por objetivo identificar os aspectos psicológicos da experiência de mães e pais em relação à retinopatia da prematuridade (ROP) de seus filhos através de entrevista psicológica. As entrevistas foram transcritas e analisadas segundo a técnica de análise de conteúdo. O impacto do diagnóstico variou de acordo com a expectativa dos pais e a compreensão sobre a doença, sendo amenizado pelo suporte familiar e profissional. As dificuldades foram sentidas em relação ao posicionamento social da criança e suas limitações. Mães e pais adiaram projetos, apresentaram insegurança e receio de sequelas futuras. A assistência psicológica pode ocorrer desde o momento do diagnóstico, levando em consideração os significados compartilhados, promovendo a adequação de expectativas e priorizando a qualidade de vida da família.

Abstract This research aims to identify the psychological aspects of how parents experience their child’s retinopathy of prematurity (ROP), through a psychological interview. The interviews were transcribed and analyzed according to the content analysis method. The impact of the diagnosis varied according to the expectations of parents and their understanding of the disease, being softened by family and professional support. The difficulties were felt regarding the social positioning of the children and their limitations. Parents postponed projects, presented insecurity and fear of future sequels. Psychological assistance can occur since the time of diagnosis, considering the shared meanings, promoting the adequacy of expectations and prioritizing the family’s quality of life.

Resumo O pequizeiro é uma espécie nativa do cerrado brasileiro, com ampla distribuição geográfica, cujo fruto é bastante apreciado na culinária, compondo pratos tradicionais. Em geral, o fruto do pequi é consumido quando maduro, na forma in natura ou nos diversos, produtos derivados tais como óleos, licores, doces, sorvetes, entre outros, envolvendo importante atividade socioeconômica geradora de emprego e renda na agricultura familiar. Este trabalho teve por objetivo avaliar o ajuste dos modelos Brody, Gompertz, Logístico e Von Bertalanffy no crescimento e no desenvolvimento de frutos de pequi, com base em suas características físicas, como diâmetro longitudinal e transversal, e massa fresca obtidos ao longo do tempo. Os parâmetros foram estimados por meio de rotinas do software R, utilizando-se do método de mínimos quadrados e o processo iterativo de Gauss-Newton. O ajuste dos modelos foi comparado, utilizando os critérios: desvio-padrão residual, coeficiente de determinação ajustado e critério de informação de Akaike corrigido. Em geral, os dados não apresentaram estrutura de erros correlacionados, e o modelo Von Bertalanffy não se ajustou aos dados de massa fresca. Os modelos apresentaram boa qualidade no ajuste aos dados de crescimento de pequi, exceto o modelo Brody para a variável massa fresca. Os modelos Gompertz e Logístico foram os que melhor descreveram as variáveis, sendo o Gompertz o mais indicado para descrever os dados de diâmetro e de massa. Com base no ajuste, observou-se um crescimento inicial lento até cerca de 20 dias após a antese; após este período, o fruto desenvolveu-se de modo mais acelerado até 90 dias e, então, apresentou tendência à estabilidade até o final da avaliação, aos 117 dias após a antese, com caráter sigmoide da curva. O fruto de pequizeiro obteve valores finais, em média, de 7,1 cm de diâmetro transversal, 6,8 cm de diâmetro longitudinal e 113g de massa fresca.

Abstract Pequi tree is a species native to the Brazilian cerrado, with wide geographic distribution, whose fruit is very appreciated in cooking, composing traditional dishes. In general, pequi fruit is consumed when ripe in the fresh form or in the various derived products such as oils, liqueurs, sweets, ice creams among others, involving important socioeconomic activity generating employment and income in family agriculture. The aim of this study was to evaluate the adjustment of Brody, Gompertz, Logistic and Von Bertalanffy models in the growth and development of pequi fruits based on their physical characteristics such as longitudinal and cross-sectional diameter and fresh mass obtained over time. Parameters were estimated using R software routines, using the least squares method and the Gauss-Newton iterative process. The adjustment of models was compared using the following criteria: residual standard deviation, adjusted determination coefficient and corrected Akaike information criterion. In general, data presented no correlation error structure and the Von Bertalanffy model did not fit fresh mass data. The models presented good quality in the adjustment to pequi growth data, except for the Brody model for fresh mass. The Gompertz and Logistic models were those that best described variables, and the Gompertz model was the most suitable to describe diameter and mass data. Based on the adjustment, a slow initial growth was observed up to about 20 days after anthesis; after this period, the fruit developed more rapidly up to 90 days and then presented a tendency to stability until the end of the evaluation period at 117 days after anthesis, with sigmoid curve character. Pequi fruits obtained final average value of 7.1 cm for cross-sectional diameter, 6.8 cm for longitudinal diameter and 113g for fresh mass.

ABSTRACT Purpose: To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island flap to complete the urethroplasty. Materials and methods: The experimental procedure with rabbits included a tunica vaginalis flap for reconstruction of the corpora after corporotomy, simulating a ventral lengthening operation. A buccal mucosa graft was placed directly on top of the flap, and the urethroplasty was completed with an onlay preputial island flap. Eight rabbits were divided into 4 groups, sacrificed at 2, 4, 8 and 12 weeks postoperatively, and submitted to histological evaluation. Results: We observed a large number of complications, such as fistula (75%), urinary retention (50%) and stenosis (50%). There were two deaths related to the procedure. Histological evaluation demonstrated a severe and persistent inflammatory reaction. No viable tunica vaginalis or buccal mucosa was identified. Conclusions: In this animal model, the association of a buccal mucosa graft over the tunica vaginalis flap was not successful, and resulted in complete loss of both tissues.

RESUMO Introdução: A leishmaniose de mucosa (LM) é uma forma clínica grave da leishmaniose. Fatores complexos ligados ao parasita e ao hospedeiro são atribuídos ao desenvolvimento das lesões de mucosa. Leishmania RNA Vírus 1 (LRV1) pode subverter a resposta imune, podendo ser o principal determinante da gravidade da doença e deve ser pesquisado. Objetivo: Estudar a existência de diferenças clínicas entre pacientes portadores de LM com endosimbiose por LRV1 e as que não possuem. Métodos: Foi realizado um estudo de coorte histórica com corte transversal com avaliação clínica, detecção da Leishmania por técnica de PCR, classificação da espécie e pesquisa de LRV1. Foram incluídos na análise da pesquisa somente os pacientes com diagnóstico confirmado de LM com PCR positivo, com lesão de mucosa nasal. Resultados: Dos 37 pacientes, 30 (81,1%) foram diagnosticados com L. braziliensis, 5 (13,5%) com L. guyanensis e 2 (5,4%) com infecção mista de L. braziliensis e L. guyanensis. O vírus LVR1 estava presente em 26 casos (70,3%). Conclusão: A correlação entre o fenótipo clínico e a presença do LRV1 não foi constatada, porém a frequência do vírus é duas vezes maior em lesão de mucosa do que encontrado em trabalho, da mesma região, sobre lesão cutânea.

ABSTRACT INTRODUCTION: Mucosal leishmaniosis (ML) is a severe clinical form of leishmaniosis. Complex factors related to the parasite and the host are attributed to the development of mucosal lesions. Leishmania RNA virus 1 (LRV1) can disrupt immune response, and may be the main determinant of severity of the disease; it should be investigated. OBJECTIVE: To study the existence of clinical differences between patients with ML with endosymbiosis by LRV1 and. those without it. METHODS: A cross-sectional cohort study with clinical evaluation, polymerase chain reaction (PCR) detection of Leishmania, species classification, and search of LRV1 was performed. Only patients with confirmed diagnosis of ML by positive PCR and with nasal mucosa injuries were included in this analysis. RESULTS: Out of 37 patients, 30 (81.1%) were diagnosed with Leishmania braziliensis, five (13.5%) with Leishmania guyanensis, and two (5.4%) with mixed infection of L. braziliensis and L. guyanensis. LVR1 virus was present in 26 (70.3%) of the cases. CONCLUSION: Correlation between clinical phenotype and presence of LRV1 was not observed, although the frequency of the virus is two-fold higher in mucosal lesions than that found in the literature on skin lesions in the same geographical area.

RESUMOObjetivo:Avaliar a influência da retinopatia da prematuridade (ROP) na qualidade de vida relacionada à visão em crianças.Método:Utilizou-se o Questionário de Função Visual Infantil - (QFVI), - um instrumento de qualidade de vida relacionada à visão em crianças, dividido em seis subescalas: Saúde Geral, Saúde da Visão, Competência, Personalidade, Impacto Familiar e Tratamento. A amostra foi constituída por pais de crianças prematuras, de até três anos de idade, com diagnóstico de ROP e ausência de sequelas neurológicas (grupo ROP) e pais de crianças de até três anos de idade, prematuras, com visão normal (grupo controle) e ausência de outras doenças associadas.Resultados:Participaram da pesquisa 88 indivíduos, 43 no grupo ROP e 45 no grupo controle. Houve redução estatisticamente significante do grupo ROP em comparação ao grupo controle em todas as subscalas do QFVI e Índice Geral. O grupo ROP foi dividido segundo a gravidade da doença. As crianças com ROP mais grave apresentaram notas inferiores e redução estatisticamente significante em comparação ao grupo de ROP menos grave no Índice Geral e nos domínios Saúde da Visão e Competência.Conclusão:A ROP apresenta impacto negativo na qualidade de vida relacionada à visão em crianças.

ABSTRACTPurpose:To evaluate the effect of retinopathy of prematurity (ROP) on vision-related quality of life in children.Methods:The Children's Visual Function Questionnaire (CVFQ), an instrument that evaluates vision-related quality of life in children, was used. It is divided into 6 subscales: General Health, Vision Health, Competence, Personality, Family Impact, and Treatment. The sample consisted of parents of premature children up to 3 years of age who had ROP and no neurological damage (ROP group) and parents of premature children up to 3 years of age who had normal vision and absence of other diseases (control group).Results:There were 88 subjects in total, 43 in the ROP group and 45 in the control group. The ROP group had lower scores on the CVFQ than the control group. The Total Index and all CVFQ subscale scores and for were significant lower in the ROP group than in the control group. The ROP group was divided according to the severity of the disease. The Total Index, Vision Health, and Competence scores in children with more severe ROP were significantly lower than those in children with less severe ROP.Conclusion:ROP was shown to have a negative effect on vision-related quality of life in children.

Purpose To compare the histological characteristics of keratinized versus non-keratinized onlay island flaps in an experimental rabbit model. Materials and Methods Sixteen male rabbits were randomly allocated into two experimental groups: keratinized and non-keratinized onlay island flaps. A defect was created in the ventral aspect of the penile urethra. In the keratinized group, a longitudinal island flap was harvested from the external prepuce and rotated to cover the urethral defect. In the non-keratinized group a transverse island flap was harvested from the inner prepuce. The animals were sacrificed after 2, 4, 8 and 12 weeks. Results The flaps were viable in all animals, and no deaths were associated with the procedure. Two urethrocutaneous fistulas were identified, one in each experimental group. A similar pattern of fibrosis was identified in both groups. The keratinized epithelium of the external prepuce kept its histological aspect and keratin production. Both keratinized and non-keratinized groups presented a slight decrease on the epithelial thickness, however without a statistically significant difference between groups. Conclusions In this short-term rabbit model, we observed that the stratified squamous keratinized epithelium from the external prepuce kept its keratin production. There was no statistical influence of the flap type on the mean epithelial thickness.

Accurate diagnosis of Helicobacter pylori infection is very important in both clinical practice and research. We evaluated the sensitivity of real-time PCR (RT-PCR) for the detection and quantification of Helicobacter pylori using DNA from 91 human gastric biopsy samples divided into three groups: 46 biopsies from untreated patients who according to the references methods were considered H. pylori-negative (group A); 35 biopsies from patients previously treated against H. pylori and considered to be cured by "gold standard" tests (group B); and 10 biopsies from patients H. pylori-positive by all available methods (group C). The sensitivity of the RT-PCR assay was higher than that of standard methods. Of the 81 patients considered to be uninfected according to the references methods, 16 were H. pylori-positive by PCR, 10 of which were patients who had received H. pylori eradication therapy and 6 were untreated patients. Based on these findings we recommend that RT-PCR should be use in addition to standard methods in clinical studies to monitor the results of H. pylori eradication therapy.

Tendo como base o debate sobre o sistema de cotas para negros nas universidades públicas, o presente artigo tem por objetivo explicitar os vários argumentos que configuram o campo de discussões acerca da implantação desse sistema, que constitui uma forma de ação afirmativa, visando a possíveis efeitos favoráveis dessa medida para o processo de construção da identidade do afro-brasileiro. Para tanto, recorreu-se à análise de diversos artigos e matérias publicadas pela imprensa escrita. Verificou-se a concentração dos debates, tanto das pessoas favoráveis ou contrárias às cotas, em seis esferas: ético/jurídica, étnica, político/assistencial, ideológica, pedagógica e das relações raciais. Por fim, concluiu-se que o debate sobre o sistema de cotas inaugura uma fase de discussões mais explícitas sobre as questões raciais, o que favorece a transformação do afro-descendente no sentido de atuar de forma crítica e emancipatória na conquista de seus direitos.

Based on the discussion about the quotas system for black descendents in the public University, the current article intends to explicit the large amount of arguments that are part of this field on the implementation of this issue, which is a positive way of action, having in mind possible and favorable effects to impose and to construct the Afro-Brazilian identity. In order to achieve this, several articles and press-released material were analyzed. This debate was focused and concentrated either on the favorable and opponent people, in six topics: ethic/judgemental, ethnical, political/assistance, ideological, pedagogical and racial relations. In this matter, the conclusion is that the quotas system debate initiates a new phase of explicit discussion on the racial issue, pushing the afrodescendents to assign a critical and emancipated way to conquer their rights.

Este trabalho visa um dos problemas sociais mais severos que acometem a população da terceira idade: a rualização. Baseado na história de vida de um sujeito emblemático dessa condição, o trabalho aponta que a rualização faz parte de um círculo de pobreza e inserção prematura no mercado de trabalho, gerador de inserções temporárias, irregulares e instáveis no sistema produtivo. A vulnerabilidade familiar, o alcoolismo e a itinerância são destacados como componentes gerais dessa situação. Como plena realização do mito de Sísifo, tais circunstâncias favorecem a constituição de indivíduos presos em um eterno presente, como se carregassem seus fardos, para cima e para baixo, sem perspectivas e sem futuro, voltados para o único horizonte que conseguem vislumbrar: a espera da morte.

This paper focus to one of the most severe social problems to the elder people: the homelessness. Based on the life of an emblematic person who lives in this condition, this study points out how the homelessness situation is related to the following circle: poverty, premature insertion to the market and the unstable market condition. This situation is composed basically by the familiar vulnerability, the alcoholism and itinerancy. As a Sisifo's Myth course conclusion, these circumstances feed up a non-perspective future condition planning that has just one certain choice: death.

No ponto de encontro entre o conceito de identidade como metamorfose humana e a categoria ideologia como forma de reproduzir relações sociais de dominação, o presente artigo discute a tipificação das pessoas em situação de rua como vagabundas, sujas, loucas, perigosas e coitadas. Tal conhecimento socialmente compartilhado acaba por legitimar a violência física contra estas pessoas, bem como servir de referência para a constituição de suas identidades pessoais. Face a este universo simbólico perverso que as acomete, são analisados a loucura (como fuga da realidade), o suicídio (como consumação material da morte simbólica em curso) e a resistência, a partir da transformação social (opondo-se a esta ideologia através da luta pelos seus direitos), como formas das pessoas em situação de rua elaborarem estas representações oriundas de suas condições sociais.

In the rendezvous of the concept of identity as cause of the human metamorphose and the category of ideology as a way to reproduce social domination, the present article discusses the labeling of the homeless people as vagabonds, dirty people, crazy persons, dangerous or poor. This feeling shared for many ends up to legitimate the physical violence against this people, as well as a bad reference in the constitution of their personal identities. Besides this perverse symbolic universe which they're submitted, are analyzed the madness- as escape from reality, the suicide - as the material consummation of the symbolic death, and the resistance against the social transformation- as an opponent to this labeling through the fight for their rights.

É descrito um caso de placentite micótica e aborto em uma égua com 7 meses de gestação. Alterações macroscópicas incluíam subdesenvolvido, áreas brancas na placenta e espessamento da membrana cório-alantóide. No pulmão fetal havia duas nodulações com 1 cm de diâmetro. Microscopicamente as lesões placentárias eram predominantemente necrótico-purulentas com focos de mineralização na placenta e trombose com inflamação purulenta no pulmão do feto. Hifas fúngicas septadas e ramificadas estavam presentes na placenta e também nos nódulos pulmonares. Aspergillus fumigatus foi isolado das lesões placentárias. O diagnóstico baseou-se nos achados histopatológicos e no isolamento do agente.

A case of mycotic placentitis with abortion in a mare in the 7th month of gestation is described. Gross changes included an underdeveloped fetus, patch whitish areas in the placenta and thickenning of the allantochorion. In the fetal lungs there were nodules of 1 cm diameter. Histopathological changes consisted mainly of necrosupurative placentitis with multifocal mineralization on the placenta and thrombosis with focal supurative inflamation in the fetal lung. Branching, septaded fungal hyphae could be demonstrated in the placental lesions and in the lungs of the fetus. Aspergillus fumigatus was isolated from the placental lesions. Diagnosis was based on the histopathology and isolation of the agent.