De Mello's Single Incision for Combined Liver-kidney Transplantation, Keeping the Kidney Retroperitoneal: A Case Report.

The combined liver-kidney transplantation (cLKT) is the procedure of choice for patients with end-stage liver and kidney disease. In cLKT we can usually accommodate the grafts in two different ways, varying the kidney placement. The retroperitoneal kidney implant has some advantages, such as the easy access or avoiding vascular complications. We propose a new single incision, not yet reported, maintaining an extraperitoneal kidney, with excellent surgical field for cLKT and possible reduction of the impact of wound complications.

Phenology, reproductive biology and growing degree days of the grapevine ‘Isabel’ (Vitis labrusca, Vitaceae) cultivated in northeastern Brazil / Fenologia, biologia reprodutiva e graus-dias da videira “Isabel” (Vitis labrusca, Vitaceae) cultivada no nordeste do Brasil

Abstract Phenology and reproductive biology of cultivated species are important for the comprehension of the requirements for fruit and seed production and the management of pollinators. This study aimed to characterise the phenology, reproductive biology and growing degree days of the grapevine ‘Isabel’ (Vitis labrusca) in northeastern Brazil during January 2011 (P1), Augst 2011 (P2), April 2012 (P3) and August 2012 (P4). We recorded the duration (days) of the phenological stages, pruning (P), woolly bud (W), budburst (B), inflorescence development (ID), flowering (F), ripening (R) and harvest (H). We analysed the floral biology, the sexual system and the breeding system. We measured the growing degree days (GDD) required to reach the subperiods P-B, B-F and F-H. The periods P1, P2, P3 and P4 lasted for 116, 125, 117 and 130 days, respectively. The number of days of harvest were similar in the same dry (P1 and P3) and rainy (P2 and P4) periods. All the periods that we recorded were shorter than those observed in other regions of Brazil, which may be attributable to the mean temperature and carbohydrate metabolism. The flowers are green, hermaphroditic, with an odour of mignonette, low pollen viability and autogamous. The base temperature of 10°C was considered the most adequate for the subperiods as has been documented for other grape varieties in Brazil. Thus, temperature was also the most adequate for the cycles, presenting a smaller standard deviation (0.119, 0.147, 0.156 and 0.153 to P1, P2, P3 and P4, respectively) when compared to a base temperature of 12°C (0.122, 0.158, 0.165 and 0.160 to P1, P2, P3 and P4, respectively). The higher and the lower observed GDD were 1972.17 and 1870.05, respectively, both above the values recorded in other parts of Brazil for same variety. The phonological results, including knowledge of growing degree days, are important to the planning of cultures at the study site and in other regions that have similar climatic conditions and make it possible to pre-determine the harvest.

Resumo Fenologia e biologia reprodutiva de espécies cultivadas são importantes para a compreensão dos requerimentos para a produção de frutos e sementes, bem como para o manejo de polinizadores. O presente estudo objetivou caracterizar a fenologia, a biologia reprodutiva e a exigência térmica (graus-dias) da videira “Isabel” (Vitis labrusca) no nordeste do Brasil, durante janeiro/2011 (P1), Agosto/2011 (P2), Abril/2012 (P3) e Agosto/2012 (P4). Analisamos a duração (dias) dos estádios fenológicos poda (PO), gema-algodão (GA), brotamento (BR), aparecimento da inflorescência (AI), florescimento (FL), início da maturação (IM) e colheita (CO). Analisamos a biologia floral, o sistema sexual e o sistema reprodutivo. As exigências térmicas foram obtidas em termos de graus-dia (GD) necessários para atingir os subperíodos PO-BR, BR-FL e FL-CO. A duração do ciclo foi de 116, 125, 117 e 130 dias para as épocas P1, P2, P3 e P4 respectivamente, sendo o número de dias de colheita semelhantes no período seco (P1 e P3) e chuvoso (P2 e P4). Todos os períodos analisados foram mais curtos do que aqueles observados em outras regiões do Brasil, o que pode ser atribuído à temperatura média e ao metabolismo de carboidratos. As flores são verdes, hermafroditas, com odor almiscarado, baixa viabilidade polínica e autógama. A temperatura base de 10ºC foi considerada a mais adequada para os subperíodos e tem sido documentada para outras variedades de uva no Brasil; portanto, a temperatura foi também a mais adequada para os ciclos, apresentando um desvio padrão menor (0,119; 0,147; 0,156 e 0,153 para P1, P2, P3 e P4, respectivamente), comparado com uma temperatura base de 12ºC (0,122; 0,158; 0,165 e 0,160 para P1, P2, P3 e P4, respectivamente). O maior é o menor GDD observado foram 1972,17 e 1870,05, respectivamente. Os resultados fenológicos, incluindo o conhecimento dos graus dias, são importantes para o planejamento de culturas no local e em outras regiões com condições climáticas semelhantes, tornando possível pré-determinar a colheita.

Ocorrência do subtipo B do vírus da imunodeficiência felina em gatos domésticos da região sul do estado do Rio Grande do Sul, Brasil / Occurrence of subtype B of the feline immunodeficiency virus in domestic cats from the south region of Rio Grande do Sul state, Brazil

No Brasil existem poucos estudos sobre a ocorrência da infecção pelo vírus da imunodeficiência felina (FIV), assim como a determinação dos subtipos circulantes, o que é indispensável para o desenvolvimento de vacinas e novos testes diagnósticos. O presente trabalho investigou a ocorrência da infecção pelo FIV entre os anos de 2010 e 2011 em gatos domésticos submetidos a atendimento clínico na cidade de Pelotas e região. Amostras de sangue total de 70 animais, incluindo suspeitos (28) ou não suspeitos (42) da infecção pelo FIV, foram submetidas à reação de PCR nested. Os resultados indicaram uma frequência de infecção de 15,7% (11/70) e a análise dos fatores associados (sexo, idade e condição clínica) evidenciou uma maior ocorrência em gatos com idade superior a 10 anos e acometidos por infecções crônicas e recidivantes. Oito amostras positivas na PCR nested foram submetidas a sequenciamento genômico e somente o subtipo B foi detectado na região estudada.

In Brazil there are few studies on the occurrence of the feline immunodeficiency virus (FIV) infection and its subtypes, which are essential for the development of vaccines and new diagnostic tests. The present study investigated the occurrence of the FIV infection between 2010 and 2011 in domestic cats submitted to medical attendance in the city of Pelotas and nearby area. Total blood samples of seventy cats, suspected (28) or not (42) of infection by FIV were analyzed by nested PCR in order to perform a diagnosis. The results pointed to a FIV infection frequency of 15.7% (11/70) and the analysis of the risk factors related to infection (sex, age and clinical condition) evidenced a greater occurrence in cats up to 10 years of age with chronic and recurrent infections. Eight samples found positive by nested PCR were submitted to DNA sequencing indicating that only the subtype B was detected in the studied region.

Case report of isochromosome 17q in acute myeloid leukemia with myelodysplasia-related changes after treatment with a hypomethylating agent.

Isochromosome 17q is a relatively common karyotypic abnormality in medulloblastoma, gastric, bladder, and breast cancers. In myeloid disorders, it is observed during disease progression and evolution to acute myeloid leukemia in Philadelphia-positive chronic myeloid leukemia. It has been reported in rare cases of myelodysplastic syndrome, with an incidence of 0.4-1.57%. Two new agents have been approved for treatment of myelodysplastic syndrome/chronic myelomonocytic leukemia. These are the hypomethylating agents, 5-azacytidine and decitabine, recommended by consensus guidelines for high-risk myelodysplastic syndrome patients not eligible for hematopoietic stem cell transplantation. We present a case of chronic myelomonocytic leukemia with normal cytogenetics at diagnosis treated with decitabine (with good response); however, the patient evolved to acute myeloid leukemia with i(17q) shortly after suspending treatment. To the best of our knowledge, this is the first report of acute myeloid leukemia with myelodysplasia-related changes with i(17q) after the use of a hypomethylating agent.

Impact of liver ex situ transection on pediatric liver transplantation.

UNLABELLED: Ex situ hepatic transection (ESHT) has allowed transplantation of younger and smaller patients than whole liver grafts. Liver transection is a technical challenge due to the prolonged back table time, possible graft lesions, and increased surgical bleeding from the cut surface. We compare the outcomes of whole versus transected liver grafts in pediatric liver transplantation. METHODS: We retrospectively studied 41 pediatric patients who underwent 42 consecutive liver transplants (1 retransplant) from cadaveric donors. The study included all patients <18 years old who were transplanted at our institution from December 2001 to September 2009. Patients were distributed into 2 groups: whole organ (WO; n = 20) and transected liver grafts (TLG; n = 21). The ESHT grafts included 17 splits and 5 reduced size livers. We evaluated the age, weight, blood component transfusions, 1-year survival, laboratory tests at 2nd and 7th days postoperatively, surgical complications, reoperations, rejection episodes, cold ischemia time, biliary reconstruction type, and donor laboratory tests. Data were analyzed using Fisher and Student's t-tests. RESULTS: The mean age was 115 months (range, 7 months to 17.6 years) in the WO group and 43.3 months (range, 5 months to 16.25 years) in the TLG group (P = .0003). Mean weight was 19.8 kg (range, 5.8-67) and 9.7 Kg (range, 5.2-57) in the WO and TLG groups, respectively (P = .0079). Red blood cell transfusion was higher in the TLG group (P = .0479). Laboratory tests showed no difference between the 2 groups considering hepatic lesions or function markers. One-year patient survivals were 90% and 85.8% among the WO and LTG, respectively (P = .588). The overall 1-year survival rate was 88.8%. CONCLUSION: ESHT allowed smaller and younger children to be transplanted. There was an increased necessity of red blood cell transfusions after hepatic transection. There was no impact on liver function or 1-year patient or graft survival after ESHT.

Late-life depression, heart failure and frontal white matter hyperintensity: a structural magnetic resonance imaging study

The relevance of the relationship between cardiac disease and depressive symptoms is well established. White matter hyperintensity, a bright signal area in the brain on T2-weighted magnetic resonance imaging scans, has been separately associated with cardiovascular risk factors, cardiac disease and late-life depression. However, no study has directly investigated the association between heart failure, major depressive symptoms and the presence of hyperintensities. Using a visual assessment scale, we have investigated the frequency and severity of white matter hyperintensities identified by magnetic resonance imaging in eight patients with late-life depression and heart failure, ten patients with heart failure without depression, and fourteen healthy elderly volunteers. Since the frontal lobe has been the proposed site for the preferential location of white matter hyperintensities in patients with late-life depression, we focused our investigation specifically on this brain region. Although there were no significant group differences in white matter hyperintensities in the frontal region, a significant direct correlation emerged between the severity of frontal periventricular white matter hyperintensity and scores on the Hamilton scale for depression in the group with heart failure and depression (P = 0.016, controlled for the confounding influence of age). There were no significant findings in any other areas of the brain. This pattern of results adds support to a relationship between cardiovascular risk factors and depressive symptoms, and provides preliminary evidence that the presence of white matter hyperintensities specifically in frontal regions may contribute to the severity of depressive symptoms in cardiac disease.

The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease.

The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.

MRI of head and neck paracoccidioidomycosis.

Paracoccidioidomycosis, caused by the dimorphic fungus Paracoccidioides brasiliensis, is the most important systemic mycosis in Latin America. Imported cases have been reported in North America, Asia and Europe, in individuals who lived in endemic areas, sometimes many years before the development of clinical manifestations. The disease causes cutaneous and/or respiratory tract mucosal lesions as well as lymph node enlargement. Involvement of the oropharynx and/or the larynx, either alone or in association with pulmonary involvement, is one of the commonest clinical presentations. On MRI, the major features are mucosal lesions, usually hypointense on T1 weighted images and hyperintense on T2 weighted or fat suppressed images, affecting the oral cavity, oropharynx and larynx, with head and neck lymph node enlargement. Differential diagnosis includes other granulomatous infectious diseases, especially tuberculosis, and cancers such as squamous cell carcinoma and lymphomas.

Anatomical variations analysis of the external jugular vein, great auricular nerve, and posterosuperior border of the platysma muscle.

This article describes the observations collected from the dissection of 10 nonformalinized cadavers analyzed in respect to the anatomical relation variations between the external jugular vein, the great auricular nerve, and the posterosuperior border of the platysma muscle.

Estudio de los niveles de CD23 soluble, IgE y eosinofilia en la respuesta inflamatoria del asma bronquial / Study of the levels of soluble CD23, I and E and eosinophile in the inflammatory reply of bronchial asthma

El CD23, descripto como una glucoproteína de 45 kDa, está relacionado con la activación de los linfocitos B y la regulación de la síntesis de IgE. Se degrada en fragmentos solubles (CD23s). Es una multicitocina involucrada en patologías con predominio de linfocitos TH2, tales como las enfermedades alérgicas, leucemia B crónica o en injerto de médula ósea. El 70 por ciento de los asmáticos presenta niveles de IgE aumentados. El eosinófilo es la célula central de la inflamación asmática. Objetivo: se evaluó la corrrelación entre niveles de CD23s, IgE sérica, eosinofilia sanguínea y esputo en asmáticos atópicos y por aspirina, frente a un grupo control de individuos normales. Pacientes: se estudiaron 27 pacientes atópicos: 14m, 13f, 10 asmáticos por AAS: 4m, 6f. Un grupo control de 10 sujetos: 5m, 5f. Nadie recibió corticoides en los dos meses previos. Se determinaron IgE total por ELISA Kabi-Pharmacia, CD23s por ELISA, Binding Site, MK112. Recuentos de eosinófilos en esputo y sangre periférica. Resultados: IgE:asmáticos atópicos: 500Ï252kU/l. Asmáticos por AAS: 68Ï27 kU/l. Controles: 51Ï20 kU/l<0.0005. CD23s: asmáticos atópicos: 7.65Ï2.25 ng/ml. Asmáticos por AAS: 3.4Ï0,95 ng/ml. Controles: 3.73Ï1.08 ng/ml; p<0.0005. Eosinófilos en esputo: asmáticos atópicos: 25Ï13 por ciento. Asmáticos por AAS: 23Ï13 por ciento. NS. Eosinofilia sanguínea: asmáticos atópicos: 685Ï316/mm3. Asmáticos por AAS: 555Ï190/mm3 NS. Control: 255Ï90mm3; p<0.0005. Conclusiones: nuestro estudio demuestra un incremento de la IgE y CD23s en los asmáticos atópicos. Los sensibles a aspirina no presentaron cambios significativos respecto del grupo control. La eosinofilia positiva se encontró en ambos grupos de asmáticos. Esto sugiere diferentes mecanismos inflamatorios en asma bronquial, con una vía común representada por los eosinófilos

How to deal with abdominoplasty in an abdomen with a scar.

Abdominoplasty is a common procedure in plastic surgery. Reviewing 150 patients who underwent abdominoplasty, it has been observed that 72% of the patients already had an abdominal scar. How to deal with abdominoplasty in an abdomen with a previous scar is discussed in this article.

Secondary rhytidoplasty.

Secondary rhytidoplasty has become a very popular procedure. Of the 100 most recent patients presenting for rhytidoplasty, 19% asked for a second face-lift. In this article, we discuss particulars of second face-lifts.

Hand rejuvenescence by fat filling.

The advantages of fat filling for hand rejuvenescence are discussed. Seventy-two patients treated by this method are presented, including their follow-up, complication rate, and details of combined operations. Preference is given to local anesthesia when no other major surgeries are associated with the method. A highly satisfactory rate was obtained (98.62%) with a low complication rate (4.15%).

Superficial musculoaponeurotic system-platysma: a continuous study.

Taking advantage of anatomical knowledge, in this report we suggest the benefits of an ample superficial musculoaponeurotic system undermining reaching the insertions of platysma muscle in the cutaneous muscles of the mouth and chin. This dissection is followed by an upward pull of the superficial musculoaponeurotic system-platysma on the face and a posterosuperior pull on the neck. The described procedure is recommended for patients presenting with drooping chin and lateral gravity bags. The method was performed in 84 of 148 patients, with excellent results.

Analysis of late results in postpregnancy mammoplasty.

The purpose of this paper is to study the alterations produced by pregnancy in women who submitted to breast reduction. We studied a group of 50 women younger than 32 years of age who submitted to this operation and had an incidence of pregnancy of 22%. The alterations of ponderable weight and increased breast volume had no relation to pregnancy. Breast ptosis was twice as frequent in the group of women who became pregnant than in the group of women who did not become pregnant. Breast-feeding was normal. We found a large percentage of women were gratified by the results of the operation (92%), and those not fully satisfied did not report any disturbances in their sexual life.

Preauricular and sideburns operating procedures for a natural look in facelifts.

Sideburn elevation, tragus elimination, earlobe dislocation, and visible scars in front of the ear are common mistakes in facelift operations. The presence of just one of these flaws spoils the result of rhytidoplasty. Surgical procedures for optimizing the preauricular scar and the location of the sideburns in the facelift procedure are discussed in this article.

The role of the superficial musculoaponeurotic system in face lift.

A study of 10 patients who underwent a unilateral dissection of the superficial musculoaponeurotic system (SMAS) is discussed. According to the different postoperative results, the patients were grouped into three classes, with either major, minor, or no obvious benefit from the SMAS dissection. The indications for and value of SMAS treatment in face lift are discussed, based on the results observed.