Sarcoma de Ewing multifocal: presentación de un caso pediátrico / Multifocal Ewing sarcoma: presentation of a pediatric case / Sarcoma de Ewing Multifocal: apresentação de um caso pediátrico

Introducción: el Sarcoma de Ewing es una neoplasia maligna de origen mesenquimático. Al momento del diagnóstico el 75% se presentan en forma localizada. Objetivo: comunicar un caso que por su presentación multifocal, generó dificultades diagnósticas. Caso clínico: niña de 6 años. Consulta por traumatismo de mano derecha tras caída de su altura 24 horas previas, constatándose en mano y puño derecho edema, calor y eritema, movilidad conservada. No fiebre. Radiografía: aumento del diámetro del tercer metacarpiano, imagen esmerilada, no trazos de fracturas. Ingresa con planteo de celulitis. Anemia leve microcítica, hipocrómica. Proteína C reactiva 82 mg/l. Recibe clindamicina intravenosa 72 horas, completa 14 días vía oral. Persistencia de alteraciones en puño y mano derecha, agrega tumoración de raíz nasal con desviación del eje, indolora. Fosfatasa alcalina, lactato deshidrogenasa, fosfatemia, calcemia normales. Resonancia magnética: alteración morfoestructural de radio, olecranon y tercer metacarpiano, fractura de olecranon y radio, reacción perióstica. Pet-Scan: lesión extensa ósea en macizo facial, tibias, cúbitos, humero derecho y clavícula. Biopsia 3er metacarpiano: tumor de células pequeñas, redondas azules, CD99 y vimentina positivo. Comienza poliquimioterapia y radioterapia sin complicaciones. Conclusiones: es frecuente que las manifestaciones clínicas iniciales sean confundidas con entidades más frecuentes, como post-traumáticas y/o inflamatorias, tal como ocurrió en este caso. Posteriormente, la aparición de nuevas lesiones y compromiso del estado general orientó el abordaje diagnóstico de la patología tumoral. La confirmación exige el estudio anatomopatológico con estudio inmunohistoquímico. La presencia de metástasis óseas constituye un factor de mal pronóstico y dificulta el abordaje terapéutico.

Introduction: Ewing's sarcoma is a malignant neoplasm of mesenchymal origin. At the time of diagnosis 75% of the cases are localized. Objective: to report a case that, due to its multifocal presentation, generated diagnostic difficulties. Clinical case: 6-year-old girl. She consulted for right hand trauma after a fall from her height 24 hours earlier, with edema, warmth and erythema in the right hand and fist, with preserved mobility. No fever. X-ray: increase in the diameter of the 3rd metacarpal, frosted image, no traces of fractures. Admitted with cellulitis. Mild microcytic anemia, hypochromic. C-reactive protein 82mg/l. Receives intravenous clindamycin 72 hours, completes 14 days orally. Persistence of alterations in fist and right hand, adds tumor of nasal root with deviation of the axis, painless. Alkaline phosphatase, lactate dehydrogenase, phosphatemia, normal calcemia. MRI: morphostructural alteration of radius, olecranon and 3rd metacarpal, fracture of olecranon and radius, periosteal reaction. Pet-Scan: extensive bone lesion in facial mass, tibiae, ulnae, right humerus and clavicle. Biopsy 3rd metacarpal: small cell tumor, blue round, CD 99 and vimentin positive. Polychemotherapy and radiotherapy were started without complications. Conclusions: it is frequent that the initial clinical manifestations are confused with more frequent entities, such as post-traumatic and/or inflammatory, as occurred in this case. Subsequently, the appearance of new lesions and compromise of the general condition guided the diagnostic approach of the tumor pathology. Confirmation requires anatomopathological study with immunohistochemical study. The presence of bone metastases constitutes a poor prognostic factor and hinders the therapeutic approach.

Introdução: O sarcoma de Ewing é um neoplasma maligno de origem mesenquimatosa. No momento do diagnóstico, 75% dos casos são localizados. Objetivo: Relatar um caso que, devido a sua apresentação multifocal, causou dificuldades diagnósticas. Caso clínico: Menina de 6 anos. Ela consultou por traumatismo à mão direita após cair de sua altura 24 horas antes, com edema, calor e eritema na mão direita e punho, com mobilidade preservada. Sem febre. Raio-X: aumento do diâmetro do 3º metacarpo, imagem fosca, sem vestígios de fraturas. Admitido com a sugestão de celulite. Anemia microcítica leve, hipocrómica. Proteína C reativa 82mg/l. Recebe clindamicina intravenosa por 72 horas, completa 14 dias por via oral. Persistência de alterações no punho e mão direita, tumor indolor da raiz nasal com desvio do eixo. Fosfatase alcalina, desidrogenase láctica, fosfataemia, calcemia normal. IRM: alteração morfo-estrutural do rádio, olecrânio e 3º metacarpo, fratura do olecrânio e do rádio, reação periosteal. Pet-Scan: extensa lesão óssea na massa facial, tíbia, ulnae, úmero direito e clavícula. Biópsia do 3º metacarpo: tumor de pequenas células, redondo azul, CD 99 e vimentina positiva. Ela iniciou a poli-quimioterapia e radioterapia sem complicações. Conclusões: É comum que as manifestações clínicas iniciais sejam confundidas com entidades mais freqüentes, tais como pós-traumáticas e/ou inflamatórias, como ocorreu neste caso. Posteriormente, o aparecimento de novas lesões e o envolvimento do quadro geral levaram a uma abordagem diagnóstica da patologia tumoral. A confirmação requer um estudo anatomopatológico com estudo imuno-histoquímico. A presença de metástases ósseas é um fator de mau prognóstico e dificulta a abordagem terapêutica.

Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy.

In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.

Effects of very short pauses on electromyographic variables measured during fatiguing isometric contractions.

15 healthy men (26.6 ± 4.6 years old, weight of 70.7 ± 8.6 kg, and height of 1.750 ± 0.072 m) performed three 30-seconds isometric contractions at 60% MVC, with two 10-seconds resting intervals between them. The goal was to study the effect of the resting intervals on the variables that are most commonly used to analyze surface electromyographic (S-EMG) signals (conduction velocity [CV], root mean square [RMS], average rectified value [ARV], mean power frequency [MNF], and median power frequency [MDF]). For the first 30-second contraction, the S-EMG variables behaved exactly like described in the literature. However, after the first and second pauses, the CV variable ceased to behave like in the literature. In the first contraction, the conduction velocity had a statistically significant decreasing trend, in the second contraction, it had a statistically non-significant positive trend, and, in the third contraction, a statistically significant positive trend. These results suggest that short pauses between isometric constant-force contractions lead to changes in the recruiting strategies of the muscles involved in the contraction. The causes of these changes are not yet clear, and further work is needed in order to understand this effect.

Estrategia de hospitalización abreviada en el síndrome bronquial obstructivo del lactante. Experiencia de tres años en Unidades de Terapia Inhalatoria. / Strategy brief hospitalization in infant wheezing bronchitis. Experience of three years in Inhalation Therapy Units

Introducción: el síndrome broncoobstructivo del lactante (SBOL) constituye el principal motivo de consulta por patología respiratoria en menores de 2 años en el invierno. Desde el año 2008 se implementaron en Montevideo y área metropolitana diez Unidades de Terapia Inhalatoria (UTIs) en un régimen de hospitalización abreviada. Se describen las características clínicas de esta población y el tratamiento instituido. Material y métodos: fueron enrolados en forma prospectiva los niños entre 1 y 24 meses con diagnóstico de SBOL moderado, sin factores de riesgo, que ingresaron a las UTIs durante los meses de invierno, entre 2008 y 2010. Fueron tratados siguiendo un algoritmo terapéutico que incluyó dos horas con salbutamol inhalado y una tercera hora con adrenalina nebulizada, según la respuesta terapéutica; se administró prednisolona a los niños con dos episodios previos o más. Resultados: se incluyeron 2.183 pacientes. La estadía media fue de 3 horas; la mediana del escore de tal al ingreso fue 5 y al egreso de 3. Requirieron 2 horas de tratamiento con salbutamol 819 niños (38%); 707 pacientes (32%) completaron tres horas y 419 (19%) recibieron además corticoides. Fueron derivados al domicilio desde la UTI 1.314 pacientes (62%), y un 13% adicional luego de observación en emergencia, con un 8% de reconsultas. Los pacientes que recibieron hasta dos horas de tratamiento tuvieron más probabilidad de alta (p<0,005). Conclusiones: la estrategia de hospitalización abreviada, mediante la protocolización de un tratamiento aplicable en el primer y segundo nivel de atención, resultó útil para el manejo del SBOL.

Evaluation of a mobile electrode for electrical stimulation of the perineal muscle.

This work evaluates the effectiveness of a new type of electrode for functional electrical stimulation of the perineal muscle in women. The new electrode is shaped like a pen, with an active stimulation electrode located on its tip. The goals of the study are to (i) demonstrate that stimulation using the new device results in increased muscle strength; and (ii) compare the performance of the new device with that of a traditional (fixed) electrode. Eight women were evaluated, following a blind study protocol. The preliminary results suggest that stimulation with the new electrode achieves better results than stimulation with traditional electrodes, as higher increases in strength were observed in the group that used the mobile electrode.

Assessing the evolution of sustainability reporting in the mining sector.

Since the 1990s several large companies have been publishing nonfinancial performance reports. Focusing initially on the physical environment, these reports evolved to consider social relations, as well as data on the firm's economic performance. A few mining companies pioneered this trend, and in the last years some of them incorporated the three dimensions of sustainable development, publishing so-called sustainability reports. This article reviews 31 reports published between 2001 and 2006 by four major mining companies. A set of 62 assessment items organized in six categories (namely context and commitment, management, environmental, social and economic performance, and accessibility and assurance) were selected to guide the review. The items were derived from international literature and recommended best practices, including the Global Reporting Initiative G3 framework. A content analysis was performed using the report as a sampling unit, and using phrases, graphics, or tables containing certain information as data collection units. A basic rating scale (0 or 1) was used for noting the presence or absence of information and a final percentage score was obtained for each report. Results show that there is a clear evolution in report's comprehensiveness and depth. Categories "accessibility and assurance" and "economic performance" featured the lowest scores and do not present a clear evolution trend in the period, whereas categories "context and commitment" and "social performance" presented the best results and regular improvement; the category "environmental performance," despite it not reaching the biggest scores, also featured constant evolution. Description of data measurement techniques, besides more comprehensive third-party verification are the items most in need of improvement.

Reabsorción cervical como consecuencia de un traumatismo múltiple: tratamiento multidisciplinario / Cervical resorption as a consequence of a multiple injury: a multidisciplinary treatment

Los traumatismos severos pueden provocar lesiones múltiples que suelen manifestarse en forma inmediata o luego de cierto tiempo. Es por esto que consideramos importante el control clínico-radiográfico a distancia, para diagnosticar las secuelas que éstos puedan ocasionar e implementar las medidas terapéuticas adecuadas para su prevención y tratamiento. Las reabsorciones cervicales son lesiones destructivas, progresivas, que se manifiestan entre otras causas, como consecuencia de traumatismos dentarios. El propósito de este trabajo es aportar datos que contribuyen a su diagnóstico temprano, para facilitar su tratamiento y, por lo tanto, evitar la destrucción de la o las piezas dentarias

Exitosa resolución de una fractura vertical / Successful resolution of a vertical fracture

Se describe el caso de una fractura vertical de tercio medio en 1.2 con ápice incompletamente calcificado. La superficie del esmalte se recubrió con resina fluida y se colocó una banda de ortodoncia para contener los trazos fracturados. En el último control radiográfico realizado a los tres años, se verificó la exitosa resolución de este caso clínico.

Obtençäo de blocos cerâmicos porosos através da adiçäo de peróxido de hidrogênio / Porous ceramic blocks obtention through of hidrogen peroxide adiction

Blocos cerâmicos porosos foram produzidos da adição de peróxido de hidrogênio à uma suspsensão de alumina. A porosidade aparente e o diâmetro dos poros, para as condições estudadas, variou de 47 a 68 por cento e de 10 a 300 µm. respectivamente. Aumentado-se o teor de peróxido de hidrogênio adicionado, a porosidade aparente e o diâmetro dos poros também aumentam. Os blocos produzidos apresentam uma distribuição de poros bastante uniforme

Abstract - Porous ceramic blocks were produced by the addition of hydrogen peroxide to a alumina slip. The apparent porosity and the diameter of the pores, for the used conditions , was between 4 7 and 68% and 1 O and 300 ~Lm, respectively. lncreasing the amount of hydrogen peroxide added, the apparent porosity and pores diameters also increased. The blocks produced by this technique presented a fairly uniform distribution of the pores