Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis

AbstractINTRODUCTIONColorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required.PRESENTATION OF CASEThe case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free.DISCUSSIONRemoval of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer.CONCLUSIONEversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas

Prevalence of psychiatric disorders in juvenile offenders in the city of Rio de Janeiro (RJ, Brazil)

Cresce no Brasil a prevalência de jovens infratores, principalmente do gênero feminino. A literatura aponta para prevalências aumentadas de transtornos mentais entre esses jovens em vários países, mas no Brasil faltam estudos. O objetivo é avaliar a prevalência de transtornos mentais em adolescentes sob medida socioeducativa, considerando como hipótese sua diferença entre gêneros com base no tipo de delito cometido. O instrumento usado foi o K-SADS-PL. Como resultados, alta prevalência de transtornos psiquiátricos entre adolescentes infratores, sendo os mais prevalentes: transtorno de déficit de atenção com hiperatividade (33%), transtorno da conduta (77%), transtorno desafiador opositivo (50%), transtornos de ansiedade (70%), transtorno depressivo (50%), abuso de drogas ilícitas (70%) e abuso de álcool (52%). O abuso de álcool aumentou em 2,4 vezes a chance de um adolescente cometer delito violento. Esses dados sugerem às autoridades em saúde pública que tanto a detecção quanto o tratamento precoce de transtornos psiquiátricos na infância podem ajudar na prevenção de atos infratores. Sugerem também que o tratamento em saúde mental dos jovens sob custódia da lei deve ser parte fundamental da recuperação e da ressocialização deles.The prevalence of juvenile offenders in Brazil, mainly among young females, is on the increase. The literature on this issue indicates an increased incidence of mental disorders among young offenders in several countries, though studies in Brazil are lacking. The aim of this article is to study the prevalence of mental disorders in adolescents from a socio-educational standpoint, taking as a hypothesis the gender difference and the type of offense committed. The instrument used was the K-SADS-PL. As results, we found a high prevalence of psychiatric disorders among juvenile offenders, the most common being: attention deficit hhyperactivity disorder (33.3%); behavioral disorder (77%); oppositional defiant disorder (50%), anxiety disorders (70%), depressive disorder (50%), illicit drug abuse/dependence (70%), and alcohol abuse/dependence (52%). Alcohol abuse/dependence caused a 2.4-fold increase in the probability of adolescents committing a violent offence. Public health authorities should concentrate on early diagnosis and treatment of psychiatric disorders in childhood to reduce future violations. It is also suggested that mental health treatment of detained juveniles should be a fundamental part of the recuperation and reintegration of young offenders into society

Intelligent System for the Estimation of Gases Dissolved in Insulating Mineral Oil from Physicochemical Tests

The objective of this work was to make the modeling through artificial neural networks of the gas concentrations dissolved in insulating mineral oil from the results of physicochemical tests. In this case, a mapping between the data of physicochemical tests and gas chromatography was obtained by means of artificial neural networks. The proposed approach proved to be efficient to identify the amount of gases, taking the following attributes as input: color degree, density, dielectric rigidity, interfacial tension, power factor of the insulating oil, neutralization index, and water level. In addition, artificial neural networks provide not only a new methodology to support decisions but also satisfactory results comparatively to actual analyses when referring to the estimation of gases

Association of pulmonary atresia with intact ventricular septum and aortic valve stenosis. Prenatal diagnosis

A rare association of pulmonary atresia with an intact septum was diagnosed through echocardiography in a fetus 32 weeks of gestational age. The diagnosis was later confirmed by echocardiography of the newborn infant and further on autopsy. The aortic valve was bicuspid with a pressure gradient of 81mmHg, and the right ventricle was hypoplastic, as were the pulmonary trunk and arteries, and the blood flow was totally dependent on the ductus arteriosus.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Optimized Method for Locating the Source of Voltage Sags

Short-Duration Voltage Variations (SDVVs) are the power quality disturbances (PQD) that mainly affect industrial systems, and are originated for various reasons, in particular short circuits over large areas, even those originating in remote points of the electrical system. The location problem aims to indicate the area or region or distance from the substation that is connected to the source causing the voltage sags, and is a fundamental task to ensure good power quality. One of the strategies used to determine the location of sources causing SDVVs and for an implementation of machine learning algorithms in modern distribution networks, called Smart Grids. Monitoring a Smart Grid plays a key role, however mostly it generates a large volume of data (Big Data) and as a result, multiple challenges arise due to the properties of this data such as volume, variety and velocity. This work presents an optimization through genetic algorithm to select meters which already exist in the Smart Grid, using a voltage sag location method in order to reduce the data obtained and analyzed throughout the localization process. Optimization was evaluated through a comparison with a non-optimized localization method, this comparison showed a difference between the hit rates of less than 1%

Composição corporal de pacientes renais crônicos em hemodiálise: antropometria e análise vetorial por bioimpedância

OBJECTIVE: to compare the body composition of patients undergoing hemodialysis with that of healthy individuals using different methods. METHOD: cross-sectional study assessing male individuals using anthropometric markers, electrical bioimpedance and vector analysis. RESULTS: the healthy individuals presented larger triceps skinfold and arm circumference (pOBJETIVO: comparar la composición corporal de pacientes en hemodiálisis con sujetos sanos, por diferentes métodos de evaluación. MÉTODOS: estudio transversal realizado con sujetos del sexo masculino con evaluaciones antropométricas, impedancia bioeléctrica y análisis vectorial. RESULTADOS: el pliegue cutáneo tricipital y la circunferencia de brazo fueron mayores (pOBJETIVO: comparar a composição corporal de pacientes em hemodiálise com sujeitos saudáveis, por diferentes métodos de avaliação. MÉTODOS: estudo transversal realizado com sujeitos do sexo masculino com avaliações antropométricas, bioimpedância elétrica e análise vetorial. RESULTADOS: a prega cutânea tricipital e a circunferência de braço foram maiores (

Multiple arterial anomalies in the newborn infant. Echocardiographic and angiographic diagnosis

Multiple arterial anomalies characterized by tortuosity and rolling of the pulmonary arteries and aorta were diagnosed on echocardiography in an asymptomatic newborn infant with a phenotype suggesting Ehlers-Danlos syndrome. These changes were later confirmed on angiography, which also showed peripheral vascular abnormalities. The electrocardiogram showed a probable hemiblock of the left anterosuperior branch, and the chest x-ray showed an excavated pulmonary trunk with normal pulmonary flow.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Determinação das características estruturais e mecânicas da liga de alta entropia Hf-Nb-Ta-Zr

In this article, the structural and mechanical behavior of the high entropy equiatomic alloy Hf-Nb-Ta-Zr was studied by using molecular dynamics simulations. The simulations were carried out in the free code LAMMPS in a system composed of 154,000 atoms interacting under the Embedded Atom Method (EAM) potential. The study was mainly focused on the body-centered cubic structure (BCC). This structure shows the highest structural stability or the lowest potential energy at 0 K. The alloy was subjected to nanoindentation tests under a spherical virtual indenter with a diameter of 40 Å. All the indentation tests were carried out at a temperature of 10 K to eliminate the thermal contributions of atoms in three crystallographic planes (001), (011), and (111) to identify anisotropic effects. The structural evolution of the alloy was analyzed by using the partial radial distribution function (PRDF), total radial distribution function (TRDF), and X-ray diffraction. The loading-unloading curves showed that the nanoindentation on the surface corresponding to the (011) plane requires the largest indentation force, of about 142 nN, while the (111) plane leads to the most significant elastic deformation before the plastic deformation onset. Neste artigo, os comportamentos estrutural e mecânico da liga equiatômica de alta entropia Hf-Nb-Ta-Zr foram estudados mediante simulações computacionais de dinâmica molecular. As simulações foram realizadas no código livre LAMMPS, em um sistema composto de 154.000 átomos que interagiram sob o potencial Embedded Atom Method (EAM). O estudo focou na estrutura cúbica de corpo centrado (CCC). Esta estrutura apresenta a maior estabilidade estrutural ou a menor energia potencial a 0 K. A liga foi submetida a ensaios de nanoindentação utilizando um penetrador virtual esférico de diâmetro de 40 Å. Ensaiou-se à temperatura de 10 K para eliminar as contribuições térmicas dos átomos, em três planos cristalográficos (001), (011) e (111), e identificar efeitos de anisotropia. A evolução estrutural da liga foi analisada mediante as funções de distribuição radial parcial (PRDF), funções de distribuição radial total (TRDF) e também por difração de raios-X. As curvas de carregamento-descarregamento mostraram que a nanoindentação na superfície correspondente ao plano (011) requer a maior força de indentação, de cerca de 142 nN, enquanto que o plano (111) conduz à maior deformação elástica antes do início da deformação plástica

Patent ductus arteriosus and pulmonary artery endarteritis

We describe a seven year old girl with echocardiographic diagnosis of pulmonary artery endarteritis as a complication of a patent ductus arteriosus, confirmed at surgery. This case illustrates the necessity of complete surgical resection of the infectious source as a way to avoid other complications such as pulmonary embolismDescrevemos uma paciente de sete anos com diagnóstico ecocardiográfico e confirmação cirúrgica de endarterite de artéria pulmonar, citada como complicação da persistência do canal arterial e ilustramos a necessidade de ressecção cirúrgica completa do processo infeccioso para evitar outras complicações, como embolia pulmonar.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Economic Assessment of Changes in the Regulation of the Transmission Activity in Colombia

The research presents an analysis of the technical, legal and economic implications generated due the change in regulating for the remuneration of the electricity transmission sector in Colombia. Economic comparisons are made of the existing and the proposal methodology by the regulatory authority in the electricity sector in Colombia. The results allow to identify the technical-economic impact generated in the companies of the transmission sector and to the users. Finally, it can be concluded that the change in remuneration will not affect the returns of investment in companies and will encourage the improvement of their electric assets and the quality of service