Tratamento laparoscópico de fibrose retroperitoneal: relato de dois casos e revisão da literatura

OBJETIVOS: Os autores apresentam os resultados de dois pacientes com fibrose retroperitoneal tratados por laparoscopia e fazem a revisão da literatura desde 1992, quando o primeiro caso de fibrose retroperitoneal tratado laparoscopicamente foi publicado. Eles também discutem as alternativas terapêuticas contemporâneas de tratamento clínico com corticosteróides e tamoxifeno. RELATO DOS CASOS: Duas mulheres, uma com fibrose retroperitoneal idiopática, e a outra com fibrose retroperitoneal associada a tireoidite de Riedel, foram operadas por laparoscopia. Ambas apresentavam obstrução ureteral pélvica bilateral e foram operadas por meio da mesma técnica: laparoscopia transperitoneal, mobilização medial de ambos os cólons, liberação dos ureteres da fibrose e intraperitonização ureteral. Cateteres Duplo-J foram inseridos antes das cirurgias e removidos três semanas depois da intraperitonização. A primeira paciente teve os dois ureteres intraperitonizados em um único procedimento. A segunda foi submetida a dois procedimentos distintos por dificuldades técnicas durante a primeira cirurgia. Ambas foram acompanhadas por mais de um ano e recuperaram-se completamente da insuficiência renal. Uma delas ainda tem dor lombar leve ocasionalmente. As urografias excretoras de ambas as pacientes não apresentam mais anormalidades. CONCLUSÕES: A correção cirúrgica da fibrose retroperitoneal, quando indicada, deve ser realizada por laparoscopia. A ureterolise e a intraperitonização de ambos os ureteres devem ser realizadas no mesmo ato cirúrgico, sempre que possível.OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation

Regioselective C5-alkylation and C5-methylcarbamate formation of 2,3-dihydro-4-pyridones and C3-alkylation and C3-methylcarbamate formation of 4-(pyrrolidin-1-yl)furan-2(5H)-one

Reactions of N-alkyl-2,3-dihydro-4-pyridones and 4-(pyrrolidin-1-yl)furan-2(5H)-one with aldehydes and triethylsilane in a one-flask procedure provided C5 and C3 alkylated derivatives, respectively. Mannich-type reactions with formaldehyde and carbamates in the presence of lithium perchlorate furnished C5/C3 methylcarbamates

Regioselective C5-alkylation and C5-methylcarbamate formation of 2,3-dihydro-4-pyridones and C3-alkylation and C3-methylcarbamate formation of 4-(pyrrolidin-1-yl)furan-2(5H)-one

Reactions of N-alkyl-2,3-dihydro-4-pyridones and 4-(pyrrolidin-1-yl)furan-2(5H)-one with aldehydes and triethylsilane in a one-flask procedure provided C5 and C3 alkylated derivatives, respectively. Mannich-type reactions with formaldehyde and carbamates in the presence of lithium perchlorate furnished C5/C3 methylcarbamates

Fauna of islands and island habitats

Na otocima nalazimo mnogo različitih staništa i životinja, koje se u većini slučajeva razlikuju od njihovih srodnika na kopnu. Te razlike ovise o vrsti otoka (kojeg je postanka), površine i udaljenosti od najbližeg kopna. MacArthurova i Wilsonova „teorija ekvilibrija“ nam to objašnjava u obliku matematičkog modela. Broj vrsta koje nastanjuju otok u bilo kojem vremenu je ravnoteža između imigracije novih vrsta i izumiranja vrsta koje su već na njemu. Kao odgovor na posebne uvijete na otocima životinje se tijekom vremena polako mijenjaju, dolazi do evolucije i zbog toga na otocima možemo pronaći mnogo endema. To sve utječe da otoci postaju „hot spots“ bioraznolikosti. Otočna staništa su područja okružena područjem ne odgovarajućeg staništa. Imaju ista obilježja kao i otoci, što je važno prilikom određivanja novih zaštićenih područja kako bi mogli povećati broj i uspješnost preživljavanja vrsta u njima. Otoci i otočna staništa su među najugroženijim staništima na planeti, zbog svoje veličine, izolacije i osjetljivosti. Utjecaji klimatskih promjena i zagađenja, zajedno sa uništavanjem biotopa, pretjeranim iskorištavanjem i invazivnim vrstama sve će biti veći, vidljiviji i pogubniji za faunu tih staništa.Islands offer a wide range of habitats for wildlife. Most hold a different animals from mainland, but that depends of types, sizes and distances from nearest mainland. The „Equilibrium Theory“ proposed by MacArthur and Wilson attempts to explain this in the form of a mathematical model. The number of species living on an island at any given time is an equilibrium between immigration and extinction rate. In response of particular conditions on the islands animals slowly change over time, they evolve. We can find lot of endemic species on islands and because of that islands are biodiversity „hot spots“. Islands habitat are areas surrounded by an area of unsuitable habitat, they can be treated like real islands. That is important to know when we are trying to define the protected areas and maximize the carrying capacity of species in them. Biodiversity loss is a particular concern on islands and island habitats. There are “among the most threatened habitats in the world”, due to their small size, isolation and fragility. It is projected that the impacts of climate change and pollution will become increasingly severe and that the impacts associated with habitat change, over-exploitation and, particularly, invasive species will continue to be very high

Shõmei Tõmatsu : la mémoire des ruines

Cette analyse se penche sur l’ouvrage de Shõmei Tõmatsu 11 ji 02 fun(11 : 02 Nagasaki), au sein duquel il travaille la ruine comme un motif particulier s’insérant au coeur d’un récit visuel. L’auteur examine également comment ce photographe transforme la ruine en un élément narratif pour expérimenter une nouvelle approche de la photographie afin de s’éloigner des conventions de la photographie réaliste de l’après-guerre japonais.This article intends to trace the historical transformation of the ruins. It starts with the work of Shõmei Tõmatsu 11 ji 02 fun (11 : 02 Nagasaki), in which the artist uses ruins as a “motif” fitting into a narrative visual fiction. This essay also examine how this photographer transforms ruins into a narrative element to try out a new approach of photography, moving away from the Japanese post-war period conventions of realistic photography

Assessment of Outcomes Among Patients With Venous Thromboembolism With and Without Chronic Kidney Disease

Importance: Patients with venous thromboembolism (VTE) and concomitant chronic kidney disease (CKD) have been reported to have a higher risk of thrombosis and major bleeding complications compared with patients without concomitant CKD. The use of anticoagulation therapy is challenging, as many anticoagulant medications are excreted by the kidney. Large-scale data are needed to clarify the impact of CKD for anticoagulant treatment strategies and clinical outcomes of patients with VTE. Objective: To compare clinical characteristics, treatment patterns, and 12-month outcomes among patients with VTE and concomitant moderate to severe CKD (stages 3-5) vs patients with VTE and mild to no CKD (stages 1-2) in a contemporary international registry. Design, Setting, and Participants: The Global Anticoagulant Registry in the Field-Venous Thromboembolism (GARFIELD-VTE) study is a prospective noninterventional investigation of real-world treatment practices. A total of 10 684 patients from 415 sites in 28 countries were enrolled in the GARFIELD-VTE between May 2014 and January 2017. This cohort study included 8979 patients (6924 patients with mild to no CKD and 2055 patients with moderate to severe CKD) who had objectively confirmed VTE within 30 days before entry in the registry. Chronic kidney disease stages were defined by estimated glomerular filtration rates. Data were extracted from the study database on December 8, 2018, and analyzed between May 1, 2019, and July 30, 2020. Exposure: Moderate to severe CKD vs mild to no CKD. Main Outcomes and Measures: The primary outcomes were all-cause mortality, recurrent VTE, and major bleeding. Event rates and 95% CIs were calculated and expressed per 100 person-years. Hazard ratios (HRs) were estimated with Cox proportional hazards regression models and adjusted for relevant confounding variables. All-cause mortality was considered a competing risk for other clinical outcomes in the estimation of cumulative incidences. Results: Of the 10 684 patients with objectively confirmed VTE, serum creatinine data were available for 8979 patients (84.0%). Of those, 4432 patients (49.4%) were female and 5912 patients (65.8%) were White; 6924 patients (77.1%; median age, 57 years; interquartile range [IQR], 44-69 years) were classified as having mild to no CKD, and 2055 patients (22.9%; median age, 70 years; IQR, 59-78 years) were classified as having moderate to severe CKD. Calculations using the equation from the Modification of Diet in Renal Disease study indicated that, among the 6924 patients with mild to no CKD, 2991 patients had stage 1 CKD, and 3933 patients had stage 2 CKD; among the 2055 patients with moderate to severe CKD, 1650 patients had stage 3 CKD, 190 patients had stage 4 CKD, and 215 patients had stage 5 CKD. The distribution of VTE presentation was comparable between groups. In total, 1171 patients (57.0%) with moderate to severe CKD and 4079 patients (58.9%) with mild to no CKD presented with deep vein thrombosis alone, 547 patients (26.6%) with moderate to severe CKD and 1723 patients (24.9%) with mild to no CKD presented with pulmonary embolism alone, and 337 patients (16.4%) with moderate to severe CKD and 1122 patients (16.2%) with mild to no CKD presented with both pulmonary embolism and deep vein thrombosis. Compared with patients with mild to no CKD, patients with moderate to severe CKD were more likely to be female (3259 women [47.1%] vs 1173 women [57.1%]) and older than 65 years (2313 patients [33.4%] vs 1278 patients [62.2%]). At baseline, the receipt of parenteral therapy alone was comparable between the 2 groups (355 patients [17.3%] with moderate to severe CKD vs 1253 patients [18.1%] with mild to no CKD). Patients with moderate to severe CKD compared with those with mild to no CKD were less likely to be receiving direct oral anticoagulant therapy, either alone (557 patients [27.1%] vs 2139 patients [30.9%]) or in combination with parenteral therapy (319 patients [15.5%] vs 1239 patients [17.9%]). Patients with moderate to severe CKD had a higher risk of all-cause mortality (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.21-1.73), major bleeding (aHR, 1.40; 95% CI, 1.03-1.90), and recurrent VTE (aHR, 1.40; 95% CI, 1.10-1.77) than patients with mild to no CKD. Conclusions and Relevance: In this study of patients with VTE, the presence of moderate to severe CKD was associated with increases in the risk of death, VTE recurrence, and major bleeding compared with the presence of mild to no CKD

Granite geomorphology of Andringirra Massif and their relation with the cenozoic evolurion of rhe Isle

[Abstract] The Andringirra Massif is a srratoide granite on the south of the Isle of Madagascar. Is a residual reliefwhich represents one ofthe last remnants of the Gondwana surface at the island egraded after the break of the supercontinent.Three different levels at 2500m, 2000m and 1500m of altitude with the etche forms associated show different stages at the evolution of the massif. Over these pediments was preserved different kinds of granite etche forms at different stages ofevolution with a very clear relation with the surface age younger fram the top to the bottom of the massif. After the exposure of the etched relief, the corresponding forms evolves suabaerially which signify that they shows two stages of evolution: one subedaphical the other subaerial

Commerce de Marbre et Remploi dans les Monuments de L’Ifriqiya Médiévale

Der Artikel untersucht das Phänomen der Wiederverwendung antiker Baumaterialien im mittelalterlichen Ifriqiya. Die historischen Chroniken und geographischen Texte heben oft die Bedeutung und den Umfang des Handels mit Marmor und anderen Materialien hervor, die den antiken Stätten entnommen wurden. Eine aufmerksame Untersuchung juristischer Texte lässt erkennen, dass sich die Rechtsgelehrten schon sehr früh mit der Frage beschäftigt haben, wie die geläufige und lukrative Praxis reguliert werden könnte. In archäologischer Hinsicht ist jedes wiederverwendete Objekt genau zu analysieren, um voreilige und irreführende Schlussfolgerungen zu vermeiden. Das wird anhand der Inschriften demonstriert, die im Mihrab der Großen Moschee von Kairouan bzw. in der al-Kasr-Moschee in Tunis gefunden worden sind

Jennifer C. POST, Sunmin YOON, and Charlotte D’EVELYN eds : Mongolian Sound Worlds

Le présent ouvrage collectif, coordonné par les ethnomusicologues étatsuniennes Jennifer C. Post, Sunmin Yoon et Charlotte D’Evelyn, est justifié par un constat : les Mongols ont toujours vécu « dans un dialogue constant avec la musique et le son » (Yoon : 1). Le propos du livre est donc d’« embrasser la situation complexe des cultures sonores mongoles à l’orée du XXIe siècle [et] de partager des informations sur un large éventail de genres et de paysages sonores [eng. soundscapes] de la cult..

Assessment of Outcomes Among Patients With Venous Thromboembolism With and Without Chronic Kidney Disease

Importance: Patients with venous thromboembolism (VTE) and concomitant chronic kidney disease (CKD) have been reported to have a higher risk of thrombosis and major bleeding complications compared with patients without concomitant CKD. The use of anticoagulation therapy is challenging, as many anticoagulant medications are excreted by the kidney. Large-scale data are needed to clarify the impact of CKD for anticoagulant treatment strategies and clinical outcomes of patients with VTE. Objective: To compare clinical characteristics, treatment patterns, and 12-month outcomes among patients with VTE and concomitant moderate to severe CKD (stages 3-5) vs patients with VTE and mild to no CKD (stages 1-2) in a contemporary international registry. Design, Setting, and Participants: The Global Anticoagulant Registry in the Field–Venous Thromboembolism (GARFIELD-VTE) study is a prospective noninterventional investigation of real-world treatment practices. A total of 10 684 patients from 415 sites in 28 countries were enrolled in the GARFIELD-VTE between May 2014 and January 2017. This cohort study included 8979 patients (6924 patients with mild to no CKD and 2055 patients with moderate to severe CKD) who had objectively confirmed VTE within 30 days before entry in the registry. Chronic kidney disease stages were defined by estimated glomerular filtration rates. Data were extracted from the study database on December 8, 2018, and analyzed between May 1, 2019, and July 30, 2020. Exposure: Moderate to severe CKD vs mild to no CKD. Main Outcomes and Measures: The primary outcomes were all-cause mortality, recurrent VTE, and major bleeding. Event rates and 95% CIs were calculated and expressed per 100 person-years. Hazard ratios (HRs) were estimated with Cox proportional hazards regression models and adjusted for relevant confounding variables. All-cause mortality was considered a competing risk for other clinical outcomes in the estimation of cumulative incidences. Results: Of the 10 684 patients with objectively confirmed VTE, serum creatinine data were available for 8979 patients (84.0%). Of those, 4432 patients (49.4%) were female and 5912 patients (65.8%) were White; 6924 patients (77.1%; median age, 57 years; interquartile range [IQR], 44-69 years) were classified as having mild to no CKD, and 2055 patients (22.9%; median age, 70 years; IQR, 59-78 years) were classified as having moderate to severe CKD. Calculations using the equation from the Modification of Diet in Renal Disease study indicated that, among the 6924 patients with mild to no CKD, 2991 patients had stage 1 CKD, and 3933 patients had stage 2 CKD; among the 2055 patients with moderate to severe CKD, 1650 patients had stage 3 CKD, 190 patients had stage 4 CKD, and 215 patients had stage 5 CKD. The distribution of VTE presentation was comparable between groups. In total, 1171 patients (57.0%) with moderate to severe CKD and 4079 patients (58.9%) with mild to no CKD presented with deep vein thrombosis alone, 547 patients (26.6%) with moderate to severe CKD and 1723 patients (24.9%) with mild to no CKD presented with pulmonary embolism alone, and 337 patients (16.4%) with moderate to severe CKD and 1122 patients (16.2%) with mild to no CKD presented with both pulmonary embolism and deep vein thrombosis. Compared with patients with mild to no CKD, patients with moderate to severe CKD were more likely to be female (3259 women [47.1%] vs 1173 women [57.1%]) and older than 65 years (2313 patients [33.4%] vs 1278 patients [62.2%]). At baseline, the receipt of parenteral therapy alone was comparable between the 2 groups (355 patients [17.3%] with moderate to severe CKD vs 1253 patients [18.1%] with mild to no CKD). Patients with moderate to severe CKD compared with those with mild to no CKD were less likely to be receiving direct oral anticoagulant therapy, either alone (557 patients [27.1%] vs 2139 patients [30.9%]) or in combination with parenteral therapy (319 patients [15.5%] vs 1239 patients [17.9%]). Patients with moderate to severe CKD had a higher risk of all-cause mortality (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.21-1.73), major bleeding (aHR, 1.40; 95% CI, 1.03-1.90), and recurrent VTE (aHR, 1.40; 95% CI, 1.10-1.77) than patients with mild to no CKD. Conclusions and Relevance: In this study of patients with VTE, the presence of moderate to severe CKD was associated with increases in the risk of death, VTE recurrence, and major bleeding compared with the presence of mild to no CKD