Emergency management of ureteral stones: Recent advances

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators’ experience, patients’ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed

O ideário neoliberal e a individualização dos processos educativos na América Latina: cidadania e direitos humanos

Trata-se de uma análise teórica em relação as consequências de um modelo econômico, social e político implementado no âmbito da ótica neoliberal de diminuição das prerrogativas do Estado-nação no atendimento das demandas sociais. O argumento que se constrói  é que o Estado-nação se apresenta cada vez mais fragilizado frente ao projeto de expansão das relações econômicas internacionais, com sérias consequências sociais. Trata-se de uma frente capitaneada especialmente por dois agentes com atuação conjunta e colaborativa, as empresas multinacionais no gerenciamento dos investimentos, e as instituições internacionais que atuam no sentido de dar guarida “legal” a esta prática. A partir desta dupla ação evidencia-se um processo de redefinição das normativas quanto ao papel do Estado-nação especialmente em relação ao papel educacional, trazendo significativas mudanças no conjunto social. No contexto deste cenário, a prerrogativa do ser cidadão ou cidadã deixa de ser de responsabilidade do Estado, passando a recair sobre as prorrogativas e capacidades individuais. Implementa-se uma diferenciação entre trabalho e emprego, atribuindo-se à instituição escolar a responsabilidade pelo aprender fazer em lugar do aprender pensar. Na América Latina, e mais particularmente no Brasil, o resultado desta lógica faz surgir, especialmente nas periferias urbanas das grandes cidades, um contingente populacional fragilizado, sem qualquer vínculo institucional sem emprego e sem assistência do Estado e, portanto, agindo de forma individualizada na busca pela sobrevivência. A partir deste quadro, analisa-se o potencial  da teoria crítica dos direitos humanos enquanto papel de resistência ao processo da individualização e de precarização dos sujeitos

Mini-sternotomy for the treatment of aortic valve lesions

OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous ¼-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided morecomfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages