Surgical treatment of complete penile duplication

Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities. The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4 years old child, without any other malformation

Metodologias interdisciplinares em estudos de geoconservação de património geológico-mineiro : o caso da antiga mina de volfrâmio das Aveleiras (Mire de Tibães) : the case of ancient Aveleiras wolfram mine (Mire de Tibães)

This work emphasizes the importance of recovery processes of abandoned mining heritage, as an example of the transformative process of an organization towards a second life cycle. This perspective reflects an important measure for sustainability, either for the organization and the surrounding environment. The Aveleira Mine is an old wolfram mine, belonging to the Monastery of St Martin of Tibães, near Braga, in the North of Portugal. It was the mother house of the Benedictine order in Portugal. By the initiative of the Tibães Monastery this mine will probably reconverted, partially, in a geosite and, probably, near future in mining museum. The work aim was to present a methodological approach, in a geoconservation point of view, allowing an ulterior partially recovering and stabilization of the Aveleiras ancient mine

Drenagem endoscópica transmural de pseudocisto pancreático: resultados a longo prazo Transmural endoscopy drainage of pancreatic pseudocyst: long-term outcome

RACIONAL: Os pseudocistos pancreáticos são complicações relativamente comuns em pacientes adultos com pancreatite. OBJETIVO: Avaliar os resultados a longo prazo da drenagem endoscópica transmural, estabelecendo seu papel no manejo do pseudocisto pancreático. MÉTODOS: Foram estudados 14 pacientes com pseudocisto de pâncreas, cuja principal queixa à apresentação foi dor no andar superior do abdome e massa abdominal palpável, submetidos a cistogastrostomia (n = 12) e cistoduodenostomia (n = 2), acompanhados clinicamente e com tomografia computadorizada de abdome por até 51 meses. A colangiopancreatografia endoscópica retrógrada era tentada em todos os casos para estudo do ducto pancreático e classificação dos cistos. RESULTADOS: A pancreatite crônica alcoólica agudizada foi responsável por 10 casos (71,5%) e a biliar por 4 (28,5%). As duas formas de drenagens (cistogastrostomia e cistoduodenostomia) endoscópicas foram efetivas. Não houve mudança na conduta terapêutica proposta; em dois pacientes a migração da órtese para o interior do pseudocisto, no momento da inserção, foi a principal complicação, sendo possível sua retirada no mesmo ato, com o uso da cesta de Dormia, sob o auxílio de fluoroscopia. Não houve mortalidade, nem recidiva até o momento. O tempo médio de permanência hospitalar foi de 3 dias. CONCLUSÃO: A drenagem endoscópica transmural se apresentou como terapêutica eficaz, com baixo índice de complicações, mortalidade nula e pequeno tempo de internação hospitalar.<br>BACKGROUND: Pancreatic pseudocysts are relatively common complications of pancreatitis in adults. OBJECTIVE: To evaluate the long-term results from transmural endoscopic drainage and thus to establish its role in managing pancreatic pseudocyst. METHODS: Fourteen patients with pancreatic pseudocyst were studied. Their main complaint was pain in the upper levels of the abdomen. They presented palpable abdominal mass and underwent cystogastrostomy (n = 12) and cystoduodenostomy (n = 2), with clinical follow-up using abdominal computed tomography for up to 51 months. Retrograde endoscopic cholangiopancreatography was attempted in all cases to study the pancreatic duct and classify the cysts. RESULTS: There were 10 cases (71.5%) of chronic pancreatitis that had become acute through alcohol abuse and 4 (28.5%) that had become acute through biliary disorders. Both types of endoscopic drainage (cystogastrostomy and cystoduodenostomy) were effective. There was no change in the therapeutic management proposed. Migration of the orthesis into the pseudocyst at the time of insertion (two cases) was the principal complication, and these could be removed during the same operation, by means of a Dormia basket, with the aid of fluoroscopy. There has so far not been any mortality or relapse. The mean hospital stay was 3 days. CONCLUSION: Transmural endoscopic drainage was an efficacious form of therapy, presenting a low complication rate and no mortality, and only requiring a short stay in hospital

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications