Morphological and functional characterization of the hemocytes from the pearl oyster Pteria hirundo and their immune responses against Vibrio infections.

Hemocyte populations of the pearl oyster Pteria hirundo were characterized at morphological, ultrastructural and functional levels. Three main hemocyte populations were identified: hyalinocytes, granulocytes and blast-like cells. Hyalinocytes were the most abundant population (88.2%) characterized by the presence of few or no granules in the cytoplasm and composed by two subpopulations, large and small hyalinocytes. Comparatively, granulocytes represented 2.2% of the hemocyte population and were characterized by the presence of numerous large electron-lucid granules in the cytoplasm. Finally, the blast-like cells (9.5%) were the smallest hemocytes, showing spherical shape and a high nucleus/cytoplasm ratio. Hemocytes exhibited a significant phagocytic capacity for inert particles (38.5%) and showed to be able to produce microbicidal molecules, such as reactive oxygen species (ROS) (ex vivo assays). The immune role of hemocytes was further investigated in the P. hirundo defense against the Gram-negative Vibrio alginolyticus. A significant decrease in the total number of hemocytes was observed at 24 h following injection of V. alginolyticus or sterile seawater (injury control) when compared to naïve (unchallenged) animals, indicating the migration of circulating hemocytes to the sites of infection and tissue damage. Bacterial agglutination was only observed against Gram-negative bacteria (Vibrio) but not against to marine Gram-positive-bacteria. Besides, an increase in the agglutination titer was observed against V. alginolyticus only in animals previously infected with this same bacterial strain. These results suggest that agglutinins or lectin-like molecules may have been produced in response to this particular microorganism promoting a specific recognition. The ultrastructural and functional characterization of P. hirundo hemocytes constitutes a new important piece of the molluscan immunity puzzle that can also contribute for the improvement of bivalve production sustainability.

Incidence of Donor Hepatic Artery Thrombosis in Liver Grafts Recognized During Organ Procurement and Backtable: A Rare but Treacherous Pitfall In Liver Transplantation.

INTRODUCTION: Donor hepatic artery thrombosis (dHAT) identified during liver procurement and backtable is a rare and little-reported event that can make liver transplants unfeasible. METHODS: This is a retrospective study of dHAT identified during liver grafts procurements or backtable procedures. All grafts were recovered from brain-dead donors. The demographic characteristics of the donors and the incidence of dHAT were analyzed. The data were also compared to a cohort of donors without dHAT. RESULTS: There was a total of 486 donors during the study period. The incidence of dHAT was 1.85% (n = 9). The diagnosis of dHAT was made during procurement in 5 cases (55.5%) and during the backtable in 4 (44.4%). Most donors were female (n = 5), with an average BMI of 28.14 ± 6.9 kg/m2, hypertensive (n = 5), and with stroke as cause of brain death (n = 8). The most prevalent site of dHAT was a left hepatic artery originating from the left gastric artery (n = 4). Of the 9 cases reported, 2 livers were used for transplantation, and 7 were discarded. Comparing those cases to a cohort of 260 donors without dHAT, we found a higher incidence of anatomic variations in the hepatic artery (P = .01) and of stroke as cause of brain death (P = .05). CONCLUSION: The occurrence of dHAT before liver procurement is a rare event, however it may become a treacherous pitfall if the diagnosis is late. Grafts with anatomic variations recovered from women with brain death due to stroke and with past history of hypertension seem to be at a higher risk of presenting dHAT.

Feasibility of Large Liver Grafts in Adults.

INTRODUCTION: Size mismatch between donor and recipients may negatively influence postoperative results of liver transplantation (LT). In deceased donor LT for adults, large grafts are occasionally rejected due to the fear of primary nonfunction. The aim of this study is to assess the feasibility of using large liver grafts in adults undergoing deceased donor LT. METHODS: We performed a retrospective study including adult patients who underwent deceased donor LT at our center between January 2006 and September 2019. Recipients with donors aged less than 18 years and those receiving split-liver grafts were excluded. Graft weight of 1800 grams was the cutoff used to divide patients in 2 groups: group 1 (graft weighing < 1800 g) and group 2 (grafts weighing ≥ 1800 g). RESULTS: A total of 806 patients were included in the study. group 1 and 2 included 722 and 84 recipients, respectively. A larger proportion of male recipients was obseved in group 2: 64.8% vs 76.2% (P = .0037). Mean graft weight in group 1 and 2 was, respectively, 1348 ± 231.81 g and 1986.57 ± 165.51 g (P < .001), which resulted in significantly higher graft weight/recipient weight ratio and graft weight/standard liver volume ratio in group 2. In group 2, there were 9 (10.71%) patients with portal vein thrombosis as well as 24 patients (28.5%) with bulky ascites and 44 grafts (52.3%) with steatosis. Primary closure of the abdominal wall was not possible in 5 patients (5.9%) from this group. Primary nonfunction was diagnosed in 14 cases (16.6%), with liver retransplantation being performed in 6 of them. Male to female sex combination occurred in 19% of LT in group 2. CONCLUSION: The use of large grafts is feasible; however, proper matching between donor and recipient is paramount, especially taking into consideration graft steatosis, portal vein thrombosis and the presence of bulky ascites.

[Adverse events in anesthesiology: analysis based on the Logbook tool used by specializing physicians in Brazil]. / Eventos adversos em anestesiologia: análise por meio da ferramenta Logbook usada por médicos em especialização no Brasil.

Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014-2015).

Mortality Trends for Neglected Tropical Diseases in the State of Sergipe, Brazil, 1980-2013.

BACKGROUND: Neglected Tropical Diseases are a set of communicable diseases that affect the population so low socioeconomic status, particularly 1.4 billion people who are living below the poverty level. This study has investigated the magnitude and mortality time trends for these diseases in the state of Sergipe, Northeast Region of Brazil. METHODS: We conducted an ecological study of time series, based on secondary data derived from the Mortality Information System of the Ministry of Health. The mortality rates (crude, age-standardized rates and proportional ratio) were calculated from the deaths due to Neglected Tropical Diseases in the state of Sergipe, from 1980 to 2013. The time trends were obtained using the Joinpoint regression model. RESULTS: Three hundred six thousand and eight hundred seventy-two deaths were certified in the state and Neglected Tropical Diseases were mentioned as the underlying cause in 1,203 certificates (0.39%). Mean number of deaths was 35.38 per year, and crude and age-standardized mortality rates were, respectively: 2.16 per 100 000 inhabitants (95% CI: 1.45-2.87) and 2.87 per 100 000 inhabitants (95% CI: 1.93-3.82); the proportional mortality ratio was 0.41% (95% CI: 0.27-0.54). In that period, Schistosomiasis caused 654 deaths (54.36%), followed by Chagas disease, with 211 (17.54%), and by Leishmaniases, with 142 (11.80%) deaths. The other diseases totalized 196 deaths (16.30%). There were increasing mortality trends for Neglected Tropical Diseases, Schistosomiasis and Chagas disease in the last 15 years, according to the age-standardized rates, and stability of the mortality trends for Leishmaniases. CONCLUSIONS: The Neglected Tropical Diseases show increasing trends and are a real public health problem in the state of Sergipe, since they are responsible for significant mortality rates. The following diseases call attention for showing greater number of deaths in the period of study: Schistosomiasis, Chagas disease and Leishmaniases. We finally suggest that public managers take appropriate actions to develop new strategies in epidemiological and therapeutic surveillance, and in the follow-up of these patients.

The surgery of the long-term central venous accesses in oncology.

The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.

Adverse events in anesthesiology: analysis based on the Logbook tool used by specializing physicians in Brazil / Eventos adversos em anestesiologia: análise por meio da ferramenta Logbook usada por médicos em especialização no Brasil

Abstract Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014-2015).

Resumo O Logbook é uma ferramenta digital, lançada pela Sociedade Brasileira de Anestesiologia em 2014 e empregada desde então. Essa ferramenta permite, aos médicos em especialização em anestesiologia, o registro e o armazenamento das atividades executadas durante o período de treinamento. Isto possibilitou a análise descritiva de um extenso banco de dados dos procedimentos anestésicos, bem como das complicações ocorridas, relatadas por esses médicos. O presente estudo compreende a revisão desses dados num período de dois anos (2014-2015).

A modified internal jugular vein access for long-term catheter placement in cancer patients.

BACKGROUND: Placement, handling, and maintenance of indwelling central venous access devices may be difficult due to anatomical, clinical, or hematologic conditions in many cancer patients needing chemotherapy. An alternative approach technique is suggested joining surgical dissection to venipuncture, assisted by fluoroscopy, as a secure way to avoid complications of long-term indwelling catheters. Although ultrasound guided puncture is a safe procedure, it is not always available or familiar to most surgeons. METHODS: At the National Cancer Institute (INCA) in Rio de Janeiro, Brazil, 1750 long-term catheter placements were performed between the years 1997 and 2005. Among those, 160 were done through an alternative technical procedure consisting of an anterior cervical cutdown approach to the internal jugular vein (IJV) followed by percutaneous visual puncture of the vein. This modified internal jugular vein access (MIJVA) was employed when other access techniques were not feasible or if other underlying conditions increase the risk of bleeding complications. RESULTS: The MIJVA procedure was successful in all 160 patients. Although it was used only as an exceptional option in difficult venous accesses, further prospective trials must be conducted, however, for comparison with other technical approaches. CONCLUSION: The MIJVA is an option that provides successful IJV dissection and safe percutaneous visual puncture overcoming anatomical pitfalls in placement of long-term venous access for chemotherapy in cancer patients.

Spinal block for urgency orthopedic surgery in Von Recklinghausen's disease patient. Case report.

BACKGROUND AND OBJECTIVES: Von Recklinghausen's disease is a neurogenetic disease due to chromosome 17 abnormality. This report aimed at describing the anesthetic approach for Von Recklinghausen's disease patient submitted to urgency orthopedic surgery. CASE REPORT: Female patient, 28 years old, with Von Recklinghausen's disease, submitted to emergency orthopedic surgery under spinal block. There have been no complications both in the intraoperative period and in the post-anesthetic care unit. Patient was discharged 4 days later. CONCLUSIONS: Spinal block was possible in this case with no need for airway handling.

Raquianestesia para cirurgia ortopédica de urgência em paciente portadora de doença de Von Recklinghausen: relato de caso / Spinal anesthesia for emergency orthopedic surgery in a patient with Von Recklinghausen disease: case report

JUSTIFICATIVA E OBJETIVOS: A doença de Von Recklinghausen é uma doença neurogenética causada por uma anomalia no cromossomo 17. O objetivo deste relato foi descrever a conduta anestésica em paciente com doença de Von Recklinghausen submetida à cirurgia ortopédica de urgência. RELATO DO CASO: Paciente do sexo feminino, 28 anos, portadora da doença de Von Recklinghausen, submetida à cirurgia ortopédica em hospital de emergência sob raquianestesia. Não apresentou complicações no período intra-operatório, nem na sala de recuperação pós-anestésica. Teve alta hospitalar no 4° dia de pós-operatório. CONCLUSÕES: No caso relatado foi possível a realização da raquianestesia sem haver necessidade de manuseio da via aérea.

Cirurgia dos cateteres de longa permanência (CLP) nos centros de transplante de medula óssea / Surgery of long-term catheters (LTC) in a bone marrow transplantation center

O capítulo disserta sobre a utilização de Cateteres de Longa Permanência (CLP) num Centro de Transplante de Medula Óssea (CTMO), abordando seus aspectos cirúrgicos com o objetivo de preparar cirurgiões para o enfrentamento de pacientes hematológicos graves, seja no preparo para um TMO ou em situações complexas durante ou após o transplante. Baseado numa experiência de 2.000 cateterismos executados pelo autor no Instituto Nacional de Câncer (INCA) é intencionado, numa narrativa didática para jovens cirurgiões, a dar orientação de prática cirúrgica necessária para o sucesso da implantação destes cateteres em pacientes de CTMOs. São mostrados e discutidos aspectos inerentes ao cateter em si, como escolha de tipos e modelos, suas indicações, as técnicas cirúrgicas a serem adotadas normalmente (com a descrição detalhada do acesso jugular interno), as situações difíceis com questões relevantes à anatomia do mediastino com seus possíveis obstáculos e a forma de vencê-los, e finalmente, os resultados e as complicações advindas do uso destes sistemas especificamente em pacientes de um CTMO.

Abordagem da ferida perineal no esvaziamento pélvico posterior: confecçäo de neo-vagina; notas de técnica

Os autores comentam a indicaçäo dos esvaziamentos pélvicos posteriores, tecem comentários sobre a invalidez sexual que este procedimento acarreta e propöem uma abordagem reparadora da ferida perineal no sentido de permitir que estas pacientes possam vir a ter um relacionamento sexual semelhante ao coito normal

Cateter valvulado para tratamento quimioterápico: técnica de implantaçäo / Catheter with anti-reflux device for chemotherapeutic treatment: implantation technic

Mostra-se a técnica de implantaçäo dos cateteres valvulados para tratamento quimioterápico de longa duraçäo. Caracterizados por um sistema valvular anti-refluxo permitindo sua utilizaçäo no sistema venoso e arterial, estes cateteres necessitam algumas particularidades de implantaçäo que säo aqui relatadas. A dissecçäo da veia jugular interna mostrou-se como a melhor opçäo através de uma sutura em bolsa na parede anterior e inserçäo do cateter sem a interrupçäo do fluxo venoso

Tratamento conservador no câncer de mama inicial / Conservative treatment of early breast cancer

Os autores propöem um Protocolo para o tratamento do carcinoma inicial da mama. Discutem as indicaçöes e mostram as vantagens sobre os outros métodos propedêuticos utilizados até o momento, analisando os resultados de 14 pacientes tratadas dentro desse protocolo

Cateter valvulado semi-implantável para tratamento quimioterápico de longa duraçäo: nova opçäo para utilizaçäo em quimioterapia venosa e arterial / Semi-implanted for long-term valvular catheter chemotheraphy: new option for use in venous and arterial chemotheraphy

Expöe-sem um cateter desenvolvido no Instituto Nacional de Câncer com a finalidade de auxiliar no tratamento quimioterápico do câncer, ao permitir uma via de acesso ao sistema vascular de longa duraçäo. Mostram-se as especificaçöes, indicaçöes e a técnica de implantaçäo deste tipo de cateter

Cateteres valvulados em oncologia: nova opçäo para vias de acesso prolongados / Valvular catheter in oncology: new option for prolonged use

Os autores relatam o desenvolvimento de um novo tipo de cateter de longa permanência, caracterizado por um sistema valvular anti-refluxo, de baixa pressäo, permitindo uma via de acesso para quimioterapia venosa ou arterial com baixos índices de contaminaçäo. Mostram sua experiência inicial com 74 cateteres implantados num período de 32 meses, com um aproveitamento global de 64,9% e um índice de contaminaçäo de 13,5%. Tecem comentários sobre técnica de implantaçäo, de manipulaçäo e manutençäo, além de sua aplicaçäo em outras áreas clínicas

Irrupção ectópica do primeiro molar permanente superior em pacientes portadores de fissura isolada de palato (fissura pós-forame incisivo) / Ectopic eruption of the upper first permanent molar in isolated cleft palate patients

A irrupção ectópica do primeiro molar superior permanente representa um distúrbio em seu padrão irruptivo que resulta em uma reabsorção atípica localizada na raiz distal do segundo molar decíduo adjacente. Pesquisou-se, neste trabalho, a prevalência dessa anomalia em 107 pacientes (65 do sexo feminino e 42 do sexo masculino) portadores de fissura isolada de palato (fissura pós-forame incisivo), operados na infância. O diagnóstico da ectopia foi realizado através de radiografias ortopantomográficas, obtidas com os pacientes na faixa etária entre 6 e 8 anos. Dos 107 pacientes, 22 apresentaram um ou ambos os primeiros molares superiores permanentes impactados (20,6 por cento), totalizando 34 dentes. Não foi encontrado dimorfismo sexual estatisticamente significante. A irrupção ectópica reversível foi mais comum, apresentando uma prevalência de 64,7 por cento contra 35,3 por cento do tipo irreversível. A ectopia manifestou-se bilateralmente em 12 pacientes e, nos 10 pacientes restantes, unilateralmente. Considerou-se a deficiência de comprimento e a retroposição da maxila em relação à base do crânio como possíveis fatores etiológicos dessa anomalia em pacientes portadores de fissura isolada de palato