Endovascular Treatment Of Renal Stenosis In Solitary Kidney

Background: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical methods and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. Objective: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. Methods: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Clínicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90% had hypertension, 70% were smokers, 40% had hyperlipidemia, 30% had carotid artery occlusive disease, 60% had chronic lower limb arterial occlusion, and 20% had diabetes mellitus. Results: Immediate success was 100%. Mean follow-up time was 40 months. Control of blood pressure occurred in 90% of the cases, and in 10% there was significant reduction in urea and creatinine levels and worsening of hypertension after the procedure. Conclusion: Endovascular treatment of renal artery stenosis is a technique that has clinical benefits in hypertension control, preserving renal function and progression of this disease, but without improvement in renal function.7299105Scoble, J., Maher, E., Hamilton, G., Dick, R., Sweny, P., Moorhead, J.F., Atherosclerotic renovascular disease causing renal impairment: A case for treatment (1989) Clin Nephrol, 31, pp. 119-122Olin, J.W., Melia, M., Young, J.R., Graor, R.A., Risius, B., Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere (1990) Am J Med, 88, pp. 46N-51NZierler, R.E., Bergelin, R.O., Isaacson, J.A., Strandness, D.E., Natural history of atherosclerotic renal stenosis: A prospective study with duplex ultrasonography (1994) J Vasc Surg, 19, pp. 250-257Wright, J.R., Shurrab, A.E., Cheung, C., A prospective study of determinants of renal function outcome and mortality in atherosclerotic renovascular disease (2002) Am J Kidney Dis, 39, pp. 1153-1161Suresh, M., Laboi, P., Mamtora, H., Kalra, P.A., Relationship of renal dysfunction to proximal artery disease severity in atherosclerotic renovascular disease (2000) Nephrol Dial Transplant, 15, pp. 631-636Hunt, J.C., Strong, C.G., Renovascular hypertension. Mechanisms, natural history and treatment (1973) Am J Cardiol, 32, pp. 562-574Davis, B.A., Crook, J.E., Vestal, R.E., Oates, J.A., Prevalence of renovascular hypertension in patients with grade III or IV hypertensive retinopathy (1979) N Engl J Med, 301, pp. 1273-1276Axelrod, D.A., Fendrick, A.M., Carlos, R.C., Percutaneous stenting of incidental unilateral renal artery stenosis: Decision analysis of cost costs and benefits (2003) J Endovasc Ther, 10, pp. 546-556Ayerdi, J., Hodgson, K.J., Ballon angioplasty and stenting for renovascular occlusive disease (2004) Persp Vasc Surg Endovasc Ther, 16, pp. 25-38Sahin, S., Cimsit, C., Andaç, N., Baltacioglu, F., Tuglular, S., Akoglu, E., Renal artery stenting in solitary functioning kidneys: Technical and clinical results (2006) Eur J Radiol, 57, pp. 131-137Shannon, H.M., Gillespie, I.N., Moss, J.G., Salvage of the solitary kidney by insertion of a renal artery stent (1998) AJR Am J Roentgenol, 171, pp. 217-222Cioni, R., Vignali, C., Petruzzi, P., Renal stenting in patients with a solitary functioning kidney (2001) Cardiovasc Intervent Radiol, 24, pp. 372-377Gruntzig, A., Kuhlmann, U., Vetterr, W., Lütolf, U., Meier, B., Siegenthaler, W., Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal artery stenosis (1978) Lancet, 1, pp. 801-802Scolari, F., Ravani, P., Pola, A., Predictors of renal and patient outcomes in atheroembolic renal disease: A prospective study (2003) J Am Soc Nephrol, 14, pp. 1584-1590Mukherjee, D., Bhatt, D.L., Robbins, M., Renal artery end-diastolic velocity and renal artery resistance index as predictors of outcome after renal stenting (2001) Am J Cardiol, 88, pp. 1064-1066Chatziiannou, A., Mourikis, D., Agroyannis, B., Renal artery stenting for renal insufficiency in solitary kidney in 26 patients (2002) Eur J Vasc Endovasc Surg, 23, pp. 49-54Sivamurthy, N., Surowiec, S.M., Culakova, E., Divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis (2004) J Vasc Surg, 39, pp. 565-574Beutler, J.J., Van Ampting, J.M., Van De Ven, P.J., Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal nsufficiency (2001) J Am Soc Nephrol, 12, pp. 1475-1481Pillay, W.R., Kan, Y.M., Crinnion, J.N., Wolfe, J.H., Joint Vascular Research Group, UK. Prospective multicentre study of the natural history of atherosclerotic renal artery stenosis in patients with peripheral vascular disease (2002) Br J Surg, 89, pp. 737-740Cherr, G.S., Hansen, K.J., Craven, T.E., Surgical management of atherosclerotic renovascular disease (2002) J Vasc Surg, 35, pp. 236-24

Aneurismas Toracoabdominais Rotos [ruptured Thoracoabdominal Aneurysms]

Objective: To evaluate the pre-, intra- and postoperative data of ruptured thoracoabdominal aneurysms operated at Hospital de Clínicas da Universidade Estadual de Campinas. Methods: A retrospective study of five patients submitted to repair of ruptured thoracoabdominal aneurysm at Hospital de Clínicas da Universidade Estadual de Campinas from September 2000 to April 2004. All patients presented a ruptured type IV thoracoabdominal aneurysm, and four of them were hemodynamically stable. Three patients were operated by the simple supraceliac aortic clamping and saline solution infusion at 4°C in the renal arteries; one patient died during the surgery before the aneurysm was opened; and one patient was operated by perfusion of oxygenated blood in the visceral arteries. Results: Of the five patients operated, two died (40%). One of them presented hemodynamic instability and died during the surgery; the other patient died on the 26 th postoperative day due to multiple organ failure. All three surviving patients progressed well, with no sequelae. Among patients who were taken to the operating room hemodynamically stable, the mortality rate was 25%. Conclusions: Patients with ruptured type IV thoracoabdominal aneurysm, hemodynamically stable, achieved satisfactory surgical results, similar to infrarenal ruptured aneurysms. Copyright © 2006 by Sociedade Brasileira de Angiologia e de Cirurgia Vascular.513741Bradbury, A.W., Bulstrode, N.W., Gilling-Smith, G., Stansby, G., Mansfield, A.O., Wolfe, J.H., Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases (1999) Eur J Vasc Endovasc Surg, 17, pp. 160-165Lewis, M.E., Ranasinghe, A.M., Revell, M.P., Bonser, R.S., Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms (2002) Br J Surg, 89, pp. 442-445Cowan Jr., J.A., Dimick, J.B., Wainess, R.M., Henke, P.K., Stanley, J.C., Upchurch Jr., G.R., Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998 (2003) J Vasc Surg, 38, pp. 319-322LeMaire, S.A., Rice, D.C., Schmittling, Z.C., Coselli, J.S., Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation (2002) J Vasc Surg, 35, pp. 1171-1178Rocha, E.F., Luccas, G.C., Baldini Neto, L., Aneurisma tóracoabdominal inflamatório (2005) J Vasc Br, 4, pp. 301-306Rocha, E.F., Guillaumon, A.T., Antunes, N., Vieira, R.W., Aneurisma toracoabdominal roto: Modificação do circuito de perfusão visceral (2004) Rev Bras Cir Cardiovasc, 19, pp. 413-416Mastroroberto, P., Chello, M., Emergency thoracoabdominal aortic repair: Clinical outcome (1999) J Thorac Cardiovasc Surg, 118, pp. 477-481Cota, A.M., Omer, A.A., Jaipersad, A.S., Wilson, N.V., Elective versus ruptured abdominal aortic aneurysm repair: A 1-year cost-effectiveness analysis (2005) Ann Vasc Surg, 19, pp. 858-861Girardi, L.N., Krieger, K.H., Altorki, N.K., Mack, C.A., Lee, L.Y., Isom, O.W., Ruptured descending and thoracoabdominal aortic aneurysms (2002) Ann Thorac Surg, 74, pp. 1066-1070Schepens, M.A., Defauw, J.J., Hamerlijnck, R.P., De Geest, R., Vermeulen, F.E., Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results (1994) J Thorac Cardiovasc Surg, 107, pp. 134-142Cambria, R.P., Davison, J.K., Zannetti, S., L'Italien, G., Atamian, S., Thoracoabdominal aneurysm repair: Perspectives over a decade with the clamp-and-sew technique (1997) Ann Surg, 226, pp. 294-303Anacleto, A., Anacleto, J.C., Aneurismas da aorta torácica e toracoabdominal (2002) Cirurgia Vascular: Cirurgia Endovascular, Angiologia, pp. 439-459. , Brito CJ. Rio de Janeiro: RevinterSantos, V.P., Ignácio, M.R., Da Silveira, D.R., Caffaro, R.A., Aneurisma toracoabdominal roto: Relato de um caso com o uso de anel rígido sulcado de Delrin intraluminal na anastomose proximal (2004) J Vasc Br, 3, pp. 383-38

Historical biogeography of the neotropical Diaptomidae (Crustacea:Copepoda)

Introduction: Diaptomid copepods are prevalent throughout continental waters of the Neotropics, yet little is\ud known about their biogeography. In this study we investigate the main biogeographical patterns among the\ud neotropical freshwater diaptomid copepods using Parsimony Analysis of Endemicity (PAE) based on species records\ud within ecoregions. In addition, we assess potential environmental correlates and limits for species richness.\ud Results: PAE was efficient in identifying general areas of endemism. Moreover, only ecoregion area showed a\ud significant correlation with diaptomid species richness, although climatic factors were shown to provide possible\ud upper limits to the species richness in a given ecoregion.\ud Conclusion: The main patterns of endemism in neotropical freshwater diaptomid copepods are highly congruent\ud with other freshwater taxa, suggesting a strong historical signal in determining the distribution of the family in the\ud Neotropics.We would like to thank to Professor Edinaldo Nelson dos Santos Silva (INPA, Brazil) for useful insight during this study. We also thank FAPESP (process 2008/02015-7, 2009/00014-6, 2011/18358-3) for financial support to GPN; and CNPq for financial support to DP (process 141702/2006-0) and MRP (process 304897/2012-4)

Endovascular Management Of Extremity Arterial Trauma

Treatment of arterial traumatic injuries is usually performed with conventional revascularization techniques. However, vascular injuries can increasingly be repaired efficiently through minimally invasive procedures. We report four cases of extremity arterial trauma treated by endovascular techniques in a reference center. All patients showed satisfactory development over a 15-month follow-up. We suggest that endovascular therapy is a promising alternative to surgery for selected patients with extremity arterial trauma.715661Deguara, J., Ali, T., Modarai, B., Burnand, K.G., Upper limb ischemia: 20 years experience from a single center (2005) Vascular, 13, pp. 84-91Huynh, T.T., Pham, M., Griffin, L.W., Management of distal femoral and popliteal arterial injuries: An update (2006) Am J Surg, 192, pp. 773-778Peck, M.A., Rasmussen, T.E., Management of blunt peripheral arterial injury (2006) Perspect Vasc Surg Endovasc Ther, 18, pp. 159-173Vasdekis, S.N., Kakisis, J.D., Lazaris, A.M., Panayiotides, J.G., Angeli, A.A., Karkaletsis, K.G., Common femoral artery injury secondary to tennis ball strike (2006) J Vasc Surg, 44, pp. 1350-1352Starnes, B.W., Arthurs, Z.M., Endovascular management of vascular trauma (2006) Perspect Vasc Surg Endovasc Ther, 18, pp. 114-129Criado, E., Marston, W.A., Ligush, J., Mauro, M.A., Keagy, B.A., Endovascular repair of peripheral aneurysms, pseudoaneurysms and arteriovenous fistulas (1997) Ann Vasc Surg, 11, pp. 253-263du Toit, D.F., Strauss, D.C., Blaszczyk, M., de Villiers, R., Warren, B.L., Endovascular treatment of penetrating thoracic outlet arterial injuries (2000) Eur J Vasc Endovasc Surg, 19, pp. 489-495du Toit, D.F., Leith, J.G., Strauss, D.C., Blaszczyk, M., Odendaal, J.V., Warren, B.L., Endovascular management of traumatic cervicothoracic arteriovenous fistula (2003) Br J Surg, 90, pp. 1516-1521Kember, P.G., Wood, R.F., Gaines, P.A., Endovascular management of a non-penetrating traumatic axillary artery occlusion (1997) Eur J Vasc Endovasc Surg, 14, pp. 227-228Mattox KL, Hirshberg A. Traumatismo vascular. In: Haimovici H, editor. Cirurgia vascular. Rio de Janeiro: Di-Livros2000. p. 480-96Strauss, D.C., du Toit, D.F., Warren, B.L., Endovascular repair of occluded subclavian arteries following penetrating trauma (2001) J Endovasc Ther, 8, pp. 529-533Kuzniec, S., Traumatismos vasculares (2002) Cirurgia vascular, pp. 706-720. , Brito CJ, editor, Rio de Janeiro: Revinter;Aun, R., Leão, P.P., Tratamento dos ferimentos vasculares por métodos endovasculares (2002) Cirurgia vascular, pp. 721-727. , Brito CJ, editor, Rio de Janeiro: Revinter;Lönn, L., Delle, M., Karlström, L., Risberg, B., Should blunt arterial trauma to the extremities be treated with endovascular techniques? (2005) J Trauma, 59, pp. 1224-1227Alvarez-Tostado, J., Tulsyan, N., Butler, B., Rizzo, A., Endovascular management of acute critical ischemia secondary to blunt tibial artery injury (2006) J Vasc Surg, 44, pp. 1101-1103Johnson SF, Johnson SB, Strodel WE, Barker DE, Kearney PA. Brachial plexus injury: association with subclavian and axillary vascular trauma. J Trauma. 1991;31:1546-50. J Vasc Bras. 2008;7(1):62-

Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students’ Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study

Background: Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored. Objective: To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability. Methods: Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results. Results: This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students’ performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions. Conclusions: If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students’ skills in the detection of caries lesions and clinical decision-making