38 research outputs found

    Case Series on Double-Barrel Stenting for the Renal Arteries Associated With Fenestrated Repair (FEVAR) of Complex Anatomy Aortic Aneurysms

    Get PDF
    The double-barrel stenting (DBS) is a technique in which 2 parallel stents are simultaneously deployed through the same reinforced fenestration, into 2 adjacent target vessels. Prior reports describe the application of this technique for the treatment of superior mesenteric artery dissection with aneurysmal degeneration, coronary artery bifurcations, aortic arch branches, and intracranial aneurysms. The DBS technique is particularly useful in the context of fenestrated repair (FEVAR) of complex anatomy aortic aneurysms when the origin of visceral arteries branch off the aorta very close to each other or present early branches. We herein describe a case series including 7 patients who underwent a FEVAR procedure for thoracoabdominal and juxtarenal aortic aneurysms in which the presence of accessory renal arteries (ARA) or early renal branches was the reason for the application of this technique. Technical success was 100% and all stents were patent in the last follow-up CT scan (follow-up range: 1.8-62.8 months). There was only 1 small endoleak from indetermined source potentially related to the DBS, but the aneurysm sac decreased in size during follow-up and no secondary intervention was needed. Therefore, the DBS technique is a viable option for the incorporation of ARA or early renal branches to a fenestrated repair of aortic aneurysms with complex anatomy

    Rare Case of Abdominal Aortic and Multiple Visceral Aneurysms in a Pediatric Patient With PIK3CA Mutation and Vasculitis

    Get PDF
    Abdominal aortic aneurysms (AAA) are most commonly observed in elderly male patients and are particularly rare in children. Among the pediatric population, they are usually diagnosed in the context of connective tissue disorders, genetic mutations, or vasculitis. The same is true of visceral arteries aneurysms. This case report describes the staged management of an 11-year-old patient presenting PIK3CA mutation and a 5.8 cm infrarenal AAA associated with bilateral common iliac arteries and multiple visceral aneurysms, the largest observed in the superior mesenteric artery (SMA = 3.2 cm). After careful evaluation, decision was made to first approach the most life-threatening lesion (the infrarenal AAA due to the large diameter) and the remaining aneurysms in secondary procedures, with special attention to the SMA aneurysm. The patient underwent a staged repair, with the first phase consisting of an aortobi-iliac graft with the distal anastomosis made at the left common iliac artery and right external iliac artery. The right hypogastric artery was ligated. The second procedure consisted of SMA aneurysm repair with a plication technique, as 7 branches were visualized coming off the aneurysm sac. Postoperative pathology analysis of the aortic and SMA aneurysms sac revealed vasculitis with a mixed inflammatory pattern and a COL3A1 gene heterozygote variant. He is currently in his 18th month after the last surgical intervention, receiving immunomodulatory therapy, with a planned follow-up by the interdisciplinary team to monitor the medications’ side effects and the diameter of the remaining visceral aneurysms

    Primary Intestinal Fibrosarcoma in Cats

    Get PDF
    Background: Fibrosarcomas are malignant neoplasms of mesenchymal origin and can have different symptoms depending on the species, age, location and etiopathogenesis. Intestinal tumors in domestic cats are common and the small intestine is the most common site; however, fibrosarcomas are rare in the intestine of all animal species. This work reports intestinal fibrosarcoma in 2 domestic cats and aims to clarify and present information concerning this neoplastic type in the gastrointestinal tract of this species.Cases: We report 2 cases of intestinal fibrosarcoma in domestic felines (Felis catus). Cat 1. A 14-year-old female Persian breed, domestic cat, was taken to the Feline Sector of the Veterinary Hospital of Small Animals (HVPA) of the Federal Rural University of Rio de Janeiro (UFRRJ). The main complaint was chronic constipation and rectal prolapse. The clinical examination revealed an ulcerated mass, measuring 4.0 cm x 1.7 cm. Cat 2. A 10-year-old female undefined breed, domestic cat, was taken to the private clinic. The main complaint was diarrhea with bloody and rectal prolapse. The clinical examination revealed nodule measuring 2.5 cm in diameter. The surgical option decided upon was to use the rectal pull-through technique in both animals. The patients had no trans-surgical or postoperative complications. The material collected during the surgical interventions was analyzed macroscopically and fixed in 10% buffered formalin for 24 h and then sent to the Histopathology Laboratory of the Pathological Anatomy Sector (SAP) at UFRRJ for the cat 1 and in private laboratoryfor the cat 2. After fixation, it was cleaved for routine microscope exam using Hematoxylin and Eosin (HE) stains and for the histochemical method of Masson’s Trichrome staining technique. Complementary immunohistochemistry tests and electron microscopy were also performed. The patients were followed up clinically, showing complete remission of the clinical signs and survival for approximately 1 year after the neoplastic resection. Discussion: There are few reports of intestinal fibrosarcomas in veterinary medicine, therefore, little is known about racial predilection, age, sex or biological behavior. As far as these authors know, this is the 6th and 7th report of this neoplasm with a primary site in the large intestine in this species. The morphological diagnosis of fibrosarcoma is relatively simple, whereas, in some cases the differential diagnosis for tumors of the peripheral nerve sheath, leiomyosarcomas and gastrointestinal stromal tumor (GIST) can be extremely difficult. The immunohistochemistry technique in these cases may not be particularly useful. The fibrosarcoma diagnosis was also confirmed by electron microscopy since no evidence was found that could lead to a neuronal origin, thus excluding tumors such as neurofibrosarcoma and schawnoma, corroborating the immunohistochemical examination. The surgical management of tumor resection with wide safety margins (minimum 2 cm) remains the “gold standard” therapy for dealing with fibrosarcomas since they have a low response rate to chemotherapy and radiotherapy and the use of these therapies as an adjuvant is controversial. The advantages of thistechnique are related to the surgical time, simplicity, easy access and reduction in the risk of abdominal contamination. Histopathological, immunohistochemistry and electron microscopy evaluations were sufficient to enable the diagnosis of an intestinal fibrosarcoma in both cats. The occurrence of this neoplasm with intestinal involvement in the feline species is rare; therefore, this description is important as it provides information about epidemiology, associated signs, differential diagnoses, biological behavior, treatment and prognosis. Keywords: feline, intestine, mesenchymal, tumors, neoplasm, rectal pull-through

    Uso do teste LF-LAM para diagnóstico de Tuberculose ativa em paciente que vive com HIV

    Get PDF
    A tuberculose (TB) é uma doença infectocontagiosa granulomatosa, de alta infectividade e baixa patogenicidade, de tropismo primariamente respiratório, mas que pode afetar outros órgãos, como linfonodos, pele, rins, intestino e cérebro. É imperativo excluir o diagnóstico de TB em pacientes diagnosticados com HIV. Este estudo se trata do relato de caso de um paciente de 30 anos, gênero masculino, sem comorbidades prévias, que comparece à Unidade de Pronto Atendimento (UPA) queixando-se de desconforto respiratório aos pequenos esforços, tosse seca, febrícula aferida diariamente, diaforese, disfagia e perda ponderal de 15 kg. Feita a suspeição clínica de tuberculose, optou-se pela solicitação do teste rápido molecular para TB, no entanto, o paciente não conseguiu produzir a amostra necessária para análise. Assim, foi solicitado o teste de antígeno urinário lipoarabinomanano, que foi positivo, permitindo o tratamento precoce dessa grave infecção. Confirmou-se, também, o diagnóstico de HIV. O desconhecimento de métodos diagnósticos alternativos para pacientes de alto risco para TB é um complexo desafio em saúde pública, dada a elevada taxa de morbimortalidade nos portadores dessa doença, sobretudo, naqueles coinfectados com o vírus HIV

    Robust estimation of bacterial cell count from optical density

    Get PDF
    Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

    Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

    Get PDF
    The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

    Get PDF
    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

    The effect of intra-abdominal pressure over the systemic arterial pressure and the abdominal aorta flow: an experimental assay

    No full text
    INTRODUÇÃO: A pressão intra-abdominal tem demonstrado possuir um importante efeito sobre a homeostase, podendo ser alterada por influência de diversos fatores. A literatura atual mostra que valores de pressão intra-abdominal acima de 200 mmHg podem ser observados mesmo durante fenômenos fisiológicos como a tosse. Relatos de caso recentemente publicados descrevem o colapso total da aorta abdominal decorrente da hipertensão intra-abdominal. Neste estudo, através de simulação, aferiu-se o grau de prejuízo ao fluxo através da aorta abdominal, bem como à pressão arterial sistêmica e pressão de perfusão abdominal durante o aumento progressivo da pressão intra-abdominal. OBJETIVOS: Estimar, através de simulação, como o aumento da pressão intra-abdominal pode influenciar o status hemodinâmico, comprometendo a pressão arterial sistêmica e o fluxo através da aorta abdominal. Averiguar a validade do uso da pressão de perfusão abdominal, na forma como é calculada atualmente, como parâmetro de monitorização hemodinâmica. MÉTODOS: Um sistema circulatório artificial possibilitou a simulação dos efeitos da pressão intra-abdominal sobre o fluxo através da aorta abdominal infrarrenal (representada por um tubo de silicone) bem como sobre a pressão arterial sistêmica. Condutos prostéticos foram colocados dentro do tubo de silicone (Dacron e endoprótese) para simular uma abordagem cirúrgica sobre a aorta. Cinco cenários de experimentação simulando situações clínicas foram definidos no ponto inicial do trabalho: hipotensão grave, hipotensão leve, normotensão, hipertensão leve e hipertensão grave. RESULTADOS: Foram analisados os dados obtidos durante o incremento progressivo da pressão intra-abdominal de 10 a 230 mmHg, considerando três diferentes espécimes (tubo de silicone / tubo de silicone + Dacron / tubo de silicone + endoprótese), cinco cenários de experimentação e sete variáveis (pressões sistólica e diastólica a montante e a jusante, fluxos sistólico e diastólico e pressão de perfusão abdominal). Conforme avaliação estatística através de análise de variância, observou-se que a pressão intra-abdominal tem uma clara influência em todas as variáveis de interesse (p < 0,001), independentemente do cenário de experimentação e do espécime considerado. Utilizando-se o teste de Tukey, na comparação dos espécimes dois a dois, observou-se que a combinação tubo de silicone + endoprótese apresentou a maior resiliência aos efeitos deletérios da pressão intra-abdominal na maior parte dos cenários de experimentação (p = 0,05), para todas as variáveis, exceto para a pressão de perfusão abdominal. A pressão de perfusão abdominal, calculada através da fórmula usada na literatura atual, apresentou as maiores reduções nos experimentos envolvendo o espécime tubo de silicone + endoprótese. CONCLUSÕES: A pressão intra-abdominal tem uma clara influência sobre todas as variáveis de interesse. A fórmula que descreve o cálculo da pressão de perfusão abdominal pode não levar em consideração a relação de dependência que pode existir entre a pressão arterial média e a pressão intra-abdominalINTRODUCTION: The intra-abdominal pressure has been shown to possess an important effect over homeostasis and might be influenced by numerous conditions. The present medical literature shows that intra-abdominal pressure values above 200 mmHg might be observed, even in physiological phenomena as coughing. Recent case reports describe the collapse of abdominal aorta due to intra-abdominal hypertension. In this study, through simulation, we measured the hazard degree to the flow through infrarenal abdominal aorta as well as to systemic arterial pressure and abdominal perfusion pressure during progressive intra-abdominal pressure increments. OBJECTIVES: To estimate, through simulation, how the intra-abdominal pressure increment would influence the hemodynamic status, compromising the systemic arterial pressure and the flow through abdominal aorta. Evaluate the validity of the abdominal perfusion pressure usage, as it is calculated today, as a reliable parameter in hemodynamic monitoring. METHODS: An artificial circulatory system enabled the simulation of the intra-abdominal pressure effects over the flow through the infrarenal abdominal aorta (represented by a silicone tube) as well as over the systemic arterial pressure. Prosthetic conduits were set inside the silicone tube (Dacron or endoprosthesis) to simulate a surgical approach over the aorta. Five experiment categories simulating clinical scenarios were defined at the study starting point: severe hypotension, slight hypotension, normotension, slight hypertension and severe hypertension. RESULTS: The data obtained along the intra-abdominal pressure increment from 10 up to 230 mmHg were analyzed considering three different specimens (silicone tube / silicone tube + Dacron / silicone tube + endoprosthesis), five experimental scenarios and seven variables of interest (upstream and downstream systolic and diastolic pressures, systolic and diastolic flow and abdominal perfusion pressure). Statistical evaluation through variance analysis showed that the intraabdominal pressure has a clear influence in all variables of interest (p < 0,001), independently of the experimental scenario or the specimen considered. The Tukey test, in the comparison of the specimens two by two, showed that the combination silicone tube + endoprosthesis had the greatest resilience to the deleterious intra-abdominal pressure effect in most part of the experimental scenarios (p = 0,05) over all the interest variables, with exception to the abdominal perfusion pressure. The abdominal perfusion pressure, calculated by the formula used in the medical literature, presented the most significant decrement along the silicone tube + endoprosthesis experiments. CONCLUSIONS: The intra-abdominal pressure has a clear influence in all variables of interest. The formula which describes the abdominal perfusion pressure calculation might not consider the dependency relationship that might exist between mean arterial pressure and the intra-abdominal pressur

    Validez de constructo y consistencia interna de la versión brasileña de Leisure Attitude Measurement para los ancianos

    No full text
    Objetivo: Avaliar a validade de constructo e a consistência interna da versão brasileira da Leisure Attitude Measurement para a pessoa idosa. Método: Estudo metodológico, de abordagem quantitativa. Os dados foram coletados durante três meses, por meio de visitas domiciliares, em amostra aleatória e representativa de 384 idosos. A consistência interna foi medida pelo coeficiente alfa de Cronbach. A validade de constructo foi avaliada pela análise fatorial exploratória. A extração dos fatores foi realizada por componentes principais, segundo o critério de Kaiser, com rotação pela solução Varimax. Resultados: Os participantes tinham em média 70,9 anos e eram, na maioria, mulheres, casados, residentes com familiares, com um a quatro anos de estudo e renda de até um salário mínimo. O modelo final do instrumento conservou três fatores, sob o critério da parcimônia, explicando 50% da variância dos dados, com 27 itens totais, distribuídos nos domínios cognitivo, afetivo e comportamental e com coeficiente alfa de Cronbach global de 0,89. Conclusão: O modelo estrutural proposto mostrou validade de constructo e consistência interna adequada e explicou 50% da variabilidade dos dados. Sua aplicação permitirá conhecer a realidade social e incentivar atitude positiva e engajamento de idosos no lazer.Objetivo: Evaluar la validez de constructo y la consistencia interna de la versión brasileña de la Leisure Attitude Measurement para los ancianos. Método: Estudio metodológico con enfoque cuantitativo. Los datos se recogieron durante tres meses, mediante visitas a domicilio, en una muestra aleatoria y representativa de 384 ancianos. La consistencia interna se midió mediante el coeficiente alfa de Cronbach. La validez de constructo se evaluó mediante el análisis factorial exploratorio. La extracción de factores se realizó por componentes principales, según el criterio de Kaiser, con rotación por solución Varimax. Resultados: Los participantes tenían una media de edad de 70,9 años y en su mayoría eran mujeres, casados, vivían con familiares, con entre uno y cuatro años de escolaridad e ingresos de hasta un salario mínimo. El modelo final del instrumento retuvo tres factores, bajo el criterio de parsimonia, explicando el 50% de la varianza de los datos, con un total de 27 ítems, distribuidos en los dominios cognitivo, afectivo y comportamental y con un coeficiente alfa de Cronbach global de 0,89. Conclusión: El modelo estructural propuesto mostró validez de constructo y consistencia interna adecuada y explicó el 50% de la variabilidad de los datos. Su aplicación permitirá conocer la realidad social y fomentar la actitud positiva y la participación de los ancianos en el ocio.Objective: To evaluate the construct validity and internal consistency of the Brazilian version of Leisure Attitude Measurement for the elderly. Method: Methodological study with a quantitative approach. The data were collected for three months through domiciliary visits to a random and representative sample of 384 elders. The internal consistency was measured through Cronbach alpha coefficient. Construct validity was evaluated through exploratory factor analysis. Factor extraction was conducted per principal components, following the Kaiser criterion, with rotation through Varimax solution. Results: The participants’ mean age was 70,9 and they were mostly women, married, living with relatives, with one to four years of education, and with an income of up to one minimum wage. The final model of the instrument has conserved three factors, under the parsimony criterion, explaining 50% of data variance, with a total of 27 items distributed across the cognitive, affective, and behavioral domains, with an overall Cronbach alpha coefficient of 0.89. Conclusion: The proposed structural model has shown construct validity and an appropriate internal consistency, explaining 50% of data variability. Its application can promote the understanding of social reality and encourage a positive attitude and elderly engagement in leisure activities
    corecore