Atividade Encarcerada: O Trabalho de Psicólogos nas Prisões / Actividad Encarnada: El Trabajo de los Psicologos en las Prisiones / Incarcerated Activity: The Work of Psychologists in Prisons

In Brazil, the presence of psychology in prisons was established by the Criminal Sentence Execution Act, in 1984, and it was intensified in the past three decades. In the paper, the results of a study are discussed to understand the activity of psychologists in the prisons in Minas Gerais, based on clinical approaches to the work. We performed a qualitative research, with content analysis of documents, observations in five pris-ons, and interviews with 14 psychologists who work at these prisons. We verified that the role of psychol-ogy in prisons has been controversial, with different institutional intersections resulting from the security and punishment logic, which seems to frequently oppose professional ethical principles. The institutional demand for classifying prisoners overlaps with the monitoring of rehabilitation programs, set forth by law. This scenario, worsened by the lack of professionals, results in obstructions in the activity, the distress of the worker, trivialization of the violation of rights, and uncritical adhesion to the repressive mechanism of the institution

No Brasil, a presença da psicologia nas prisões foi instituída pela Lei de Execução Penal, em 1984, e se intensificou nas últimas três décadas. No artigo, são discutidos os resultados de um estudo para compreender a atuação dos psicólogos nos presídios de Minas Gerais, a partir das Abordagens Clínicas do Trabalho. Realizamos uma pesquisa qualitativa, com análise de conteúdo de documentos, observações em cinco presídios e entrevistas com quatorze psicólogos que atuam nesses presídios. Verificamos que o papel da Psicologia nas prisões tem sido controverso, com diferentes atravessamentos institucionais decorrentes da lógica da segurança e da punição, e que parecem frequentemente contrariar os princípios éticos profissionais. A demanda institucional para a classificação dos presos se sobrepõe ao monitoramento dos programas de reabilitação, previstos em lei. Esse cenário, agravado pela escassez de profissionais, resulta em obstruções na atividade, angústia do trabalhador, naturalização da violação de direitos e adesão acrítica ao mecanismo repressivo da instituição.

Vulnerabilidade e precariedade em uma favela carioca: ruídos, controles e convenções a partir do Programa Bolsa Família / Vulnerabilty and precariousness in a favela in Rio de Janeiro: noises, control and conventions of the Bolsa Família Program

Resumo O artigo discute como o Programa Bolsa Família (PBF) é mobilizado e significado nas práticas e discursos de beneficiárias em uma favela no Rio de Janeiro. O material empírico do qual se parte é uma pesquisa de campo na Favela do Tripé (nome fictício), trecho precário de uma favela maior, que envolveu observação participante e a interação com beneficiárias do Programa. A partir das falas destas mulheres, refletimos sobre a relação entre o PBF, vulnerabilidades, saúde, alimentação, convenções de gênero e o papel e presença do Estado em contextos de favela. A questão do cuidado, representada pela posição central das mães/mulheres, também é um dos fios condutores da análise, mostrando como o ato de cuidar reitera convenções morais. A partir dos ruídos - que vão desde os tiroteios aos gritos de mães -, realiza-se também uma discussão sobre a posição da mulher e o seu papel enquanto cuidadora e mãe, abordando as expectativas daquele grupo. Estas expectativas reafirmam convenções de gênero e deixam evidente a moralização do lugar feminino e da condição materna. Para além da violência estatal e dos agentes do crime organizado, dos controles e vigilâncias difusos, no Tripé, a outra dimensão da sociabilidade dos moradores aqui abordada diz respeito à vulnerabilidade e à precariedade.

Abstract The article discusses how the Bolsa Família Program (PBF) is mobilized and gains different meanings in the practices and discourses of beneficiaries in a favela in Rio de Janeiro. The empirical material comes from fieldwork research in the Favela do Tripé (fictitious name), a precarious stretch of a larger favela which involved participant observation and interaction with the Program beneficiaries. From these women's speeches, we reflect on the relationship among the PBF and vulnerabilities, food, health, gender conventions, and the role and presence of the State in favela contexts. The issue of care, represented by the central position of mothers/women, is also one of the conducting axis of the analysis, showing how the act of care reiterates moral conventions. From the noises - ranging from shootings to the screams of mothers - there is also a discussion about the position of the woman and her role as caregiver and mother, addressing that group's expectations. These expectations reaffirm gender conventions and make evident the moralization of the female place and the maternal condition. In addition to State violence, organized crime agents and diffuse controls and surveillance in the Favela do Tripé, the other dimension of sociability of the residents addressed here concerns vulnerability and precariousness.

A tecnologia e a atividade dos psicólogos e psicólogas em tempos da pandemia de COVID-19: desafios e apontamentos / Technology and the psychologists' role in COVID-19 times: challenges and notes / La tecnología y la actividad de los psicólogos en tiempos de COVID-19: desafíos y apuntes

Este artigo discute a relação entre o trabalho dos psicólogos e psicólogas e a tecnologia, no contexto marcado pela pandemia da covid-19. Com base na análise da dupla condição da Psicologia, como ciência e profissão, historicamente construída e reproduzida, o texto propõe uma análise crítica da intensificação do uso das Tecnologias de Informação e Comunicação (TIC), com ênfase na atividade de atendimentos clínicos individuais, por se tratar de uma modalidade de serviço em flagrante expansão no atual contexto, em razão das contingências impostas pela pandemia. Como resultados preliminares, evidencia-se o crescimento, sem precedentes, do número de cadastros de psicólogos e psicólogas interessados em realizar atendimento online e observam-se ações dos órgãos reguladores da profissão que objetivam fiscalizar tais práticas e impedir o uso indevido da tecnologia. Ressaltam-se, neste cenário, os riscos da "uberização" do trabalho do psicólogo e psicóloga e de uma retração do campo da Psicologia como profissão.

This article discusses, in the context marked by the Covid-19 pandemic, the relationship between the work of psychologists and technology. Based on the analysis of the double role of Psychology as science and profession, historically constructed and reproduced, the text proposes a critical analysis of the intensified use of Information and Communications Technology (ICT), especially regarding the activity of individual clinical care as a kind of service in clear expansion in the current context, due to the restrictions imposed because of the pandemic. As a preliminary result, it is observed an unprecedented growth of registration numbers of psychologists interested in providing online care, as much as the actions of the professional councils aiming to inspect such practices and prevent the misuse of technology. In this scenario, we stress the risks of the uberization of the psychologist's work, and a shrinking of the professional field.

Este artículo analiza la relación entre el trabajo de los psicólogos y la tecnología, en el contexto marcado por la pandemia Covid-19. A partir del análisis de la doble condición de la Psicología, como ciencia y profesión, históricamente construida y reproducida, el texto propone un análisis crítico de la intensificación del uso de las Tecnologías de Información y Comunicación (TIC), con énfasis en la actividad de atención clínica individual, por ser una modalidad de servicio en flagrante expansión en el contexto actual, debido a las contingencias impuestas por la pandemia. Como resultado preliminar es observado un crecimiento sin precedentes del número de registros de psicólogos interesados en realizar la asistencia en línea, al lado de las acciones de los organismos reguladores de la profesión para inspeccionar tales prácticas. En este contexto, al mismo tiempo, se señalan los riesgos de "uberización" del trabajo del psicólogo y de una retracción del campo de la psicología como profesión.

Appropriateness of Radiology Test Requests by an Emergency Department: A Retrospective Study.

INTRODUCTION: Imaging tests are essential for diagnosis in the emergency context and convey clinical information that is essential to assess the appropriateness of the tests and improve their interpretation. Therefore, we aimed to analyze the imaging tests requested by the Emergency Department in a district hospital. MATERIAL AND METHODS: We retrospectively analyzed computed tomography and ultrasound scans requested by the Emergency Department at the Centro Hospitalar Universitário do Algarve and considered the following variables: requested test, clinical information provided (complete/incomplete), appropriateness of the test (appropriate/inappropriate), outcome (presence/absence of relevant findings) and findings related to the clinical information (yes/no). Pearson's chi-squared and odds ratio association tests were used to evaluate the statistical association between the variables. RESULTS: Out of 1427 requests, only 219 (15.3%) were considered to have complete clinical information. Nonetheless, 1075 (75.3%) requests were considered appropriate. Relevant findings were present in about one-third (n = 453; 31.7%) and most of these findings were related to the clinical context (n = 410; 90.5%). There was a significant association between test appropriateness and the presence of relevant findings in the test (p < 0.001). The odds ratio of having a relevant finding was 5.0 times higher in the tests considered appropriate when compared with those classified as inappropriate (CI = 3.4 - 7.3; p < 0.001). DISCUSSION: The fact that appropriate tests potentiate the probability of having a relevant finding emphasizes the importance of defining guidelines so that only the adequate tests are performed. CONCLUSION: Creating guidelines should improve the appropriateness of imaging tests requested in the Emergency Department, yielding their result, with the consequent rationalization of the available resources.

Introdução: Os exames de imagem são essenciais para o diagnóstico em contexto de emergência, sendo a informação clínica determinante para verificar a sua adequação e melhorar a sua interpretação. O nosso objetivo compreendeu a análise dos exames de imagem requisitados pelo Departamento de Emergência num hospital distrital. Material e Métodos: Realizámos uma análise retrospetiva das tomografias computorizadas e ecografias requeridas pelo Departamento de Emergência no Centro Hospitalar Universitário do Algarve considerando as seguintes variáveis: exame requisitado, informação clínica fornecida (completa/incompleta), adequação do exame (adequado/não adequado), resultado (presença/ausência de achados relevantes) e relação dos achados com contexto clínico (relacionados/não relacionados). A associação entre variáveis foi avaliada utilizando as análises qui-quadrado de Pearson e razão de possibilidades. Resultados: Das 1427 requisições, apenas 219 (15,3%) foram consideradas como contendo informação clínica completa. No entanto, 1075 (75,3%) requisições foram consideradas adequadas. Cerca de um terço dos exames continha achados relevantes (n = 453; 31,7%) e a maioria destes achados estavam relacionados com o contexto clínico (n = 410; 90,5%). Encontrámos associações significativas entre a adequação do pedido e presença de achados clínicos relevantes (p < 0,001). A razão de possibilidades de ter um achado relevante é 5,0 vezes maior nos pedidos adequados relativamente aos não adequados (IC = 3,4 - 7,3; p < 0,001). Discussão: O facto de os exames adequados potenciarem a probabilidade de existir um achado relevante enfatiza a importância da definição de diretrizes para que só os exames adequados sejam realizados. Conclusão: A criação destas diretrizes deverá aumentar a adequação dos exames de imagem solicitados no Departamento de Emergência, otimizando o seu resultado, com a consequente racionalização dos recursos disponíveis.

Manicômio Judiciário e Agentes Penitenciários: entre Reprimir e Cuidar / Judicial Asylums and Prison Guards: Between Repressing and Caring / Manicomio Judicial y Agentes Penitenciarios: entre Reprimir y Cuidar

Os manicômios judiciários são instituições destinadas a acolher pessoas que cometem crimes e que, por motivo de doença ou deficiência mental, são consideradas inimputáveis, também tratadas como "louco infrator" ou "paciente judiciário". O presente artigo, baseado em pressupostos críticos da Psicologia do Trabalho, discute resultados obtidos a partir de uma pesquisa de mestrado em um manicômio judiciário de Minas Gerais. O estudo buscou compreender a atividade dos agentes penitenciários, responsáveis por garantir a ordem e a segurança do estabelecimento e de todos os indivíduos ali presentes. Constatou-se que sua atividade não se restringe à segurança, mas que abrange o cuidado, o envolvimento afetivo e a preocupação com os indivíduos custodiados naquela instituição. Se o trabalho de agente penitenciário é socialmente marginalizado, verificou-se que ele é valorizado pelos sujeitos que o executam, mesmo que estes se deparem com a ambivalência inerente à natureza do manicômio judiciário. Entre a prescrição de reprimir e o apelo a cuidar, os agentes enfrentam uma realidade marcada pelo duplo sofrimento do paciente judiciário: o rótulo da loucura e a privação da liberdade....(AU)

The judicial asylums are institutions designed to accommodate individuals who commit crimes and who, because of illness or mental disability, are considered not imputable, also treated as "judicial patient" or "crazy offender". This article, based on critical assumptions of work psychology, discusses results obtained from a master's research carried out in a judicial asylum of Minas Gerais. The study searched to understand the activity of the prison guards, responsible for ensuring the order and safety of the establishment and of all individuals present there. It was found that their activity is not restricted to security, but that it includes care, affective involvement and concern with the individuals guarded in that institution. If the work of penitentiary agent is socially marginalized, we could verify that it is valued by the subjects who execute it, even if they are faced with the ambivalence inherent in the nature of the judiciary asylum. Between the prescription of repression and the call to care, the agents face a reality marked by the double suffering of the "judicial patient": the label of madness and the deprivation of freedom...(AU)

Los manicomios judiciales son instituciones destinadas a acoger a personas que cometen crímenes y que, por motivo de enfermedad o discapacidad mental, son consideradas inimputables, también tratadas como "loco infractor" o "paciente judicial". El presente artículo, basado en supuestos críticos de la psicología del trabajo, discute resultados obtenidos a partir de una investigación de maestría en un manicomio judicial de Minas Gerais. El estudio buscó comprender la actividad de los agentes penitenciarios, responsables de garantizar el orden y la seguridad del establecimiento y de todos los individuos allí presentes. Se constató que su actividad no se restringe a la seguridad, sino que abarca el cuidado, la implicación afectiva y la preocupación con los individuos custodiados en aquella institución. Si el trabajo de agente penitenciario es socialmente marginado, se ha comprobado que es valorado por los sujetos que lo ejecutan, aunque éstos se enfrenten a la ambivalencia inherente a la naturaleza del manicomio judicial. Entre la prescripción de reprimir y el llamamiento a cuidar, los agentes enfrentan una realidad marcada por el doble sufrimiento del "paciente judicial": el rótulo de la locura y la privación de la libertad....(AU)

Você, dona de casa: trabalho, saúde e subjetividade no espaço doméstico / You, housewife: work, health and subjectivity in domestic space / Vós, ama de casa: trabajo, salud y subjetividad en el espacio doméstico

O trabalho doméstico, remunerado ou não, tem sido historicamente atribuído à mulher, surgindo como encargo específico do papel de gênero feminino e assumindo um caráter de invisibilidade e desvalorização social. Neste artigo, sugerimos um viés de análise que considera a atividade além de sua institucionalização econômica, como ação prática e psíquica, sede de investimentos vitais e de transformação de si e do mundo. Por meio da revisão de literatura, mostramos que o trabalho doméstico apresenta contornos de submissão e permanece vinculado à mulher. Discutimos o trabalho como instituição, passível de ser construído e desconstruído, e relacionamos os afazeres domésticos às atividades rejeitadas que permanecem nos bastidores, acarretando também sua perda de sentido, segundo as perspectivas das clínicas do trabalho.

The housework, remunerated or not, has been historically attributed to women, arising as a specific task of the feminine gender role and taking on a character of invisibility and social devaluation. In this article, we suggest an analysis bias that considers the activity beyond it's economic institutionalization, as a practical and psychic action, focus of vital investments and transformation of oneself and the world. Through the literature review, we show that domestic work presents contours of submission and remains linked to women. We discuss work as an institution, which can be constructed and deconstructed, and we relate the housework to the rejected activities that remain behind the scenes, also leading to their loss of meaning according to the perspectives of the work clinics.

El trabajo doméstico, remunerado o no, ha sido históricamente atribuido a la mujer, surgiendo como encargo específico del papel de género femenino y asumiendo un carácter de invisibilidad y devaluación social. En este artículo, sugerimos una línea de análisis que considera la actividad más allá de su institucionalización económica, como acción práctica y psíquica, sede de inversiones vitales y de transformación de sí y del mundo. Por medio de la revisión de literatura, mostramos que el trabajo doméstico presenta contornos de sumisión y permanece vinculado a la mujer. Discutimos el trabajo como institución, pasible de ser construido y deconstruido, y relacionamos los quehaceres domésticos a las actividades rechazadas que permanecen entre bastidores, acarreando también su pérdida de sentido, según las perspectivas de las clínicas del trabajo.

A produção da vítima empreendedora de seu resgate social: juventudes, controles e envolvimentos / The production of victims as entrepreneurs of their social redemption: young people, control and involvement

Resumo Partindo de trabalho de campo etnográfico e entrevistas grupais com jovens e gestores de projetos sociais de localidades pobres do Rio de Janeiro, o artigo problematiza a associação entre juventude e vulnerabilidades e as suas possíveis implicações no reforço de estereótipos negativos sobre os jovens pobres, por meio de discursos que privilegiam a autogestão. Explora a ideia de produção da vítima empreendora do seu regaste social tendo como pano de fundo uma reflexão sobre os usos da categoria envolvido-com-o-crime, disseminada no senso comum como uma nova forma de rotulação criminal. A análise recobre os investimentos materiais e simbólicos feitos em torno da juventude pobre, destinatários dos chamados projetos sociais, refletindo sobre as manobras de sentidos que encobrem a provisoriedade dessas iniciativas, marcadas por uma lógica do mérito e salvacionista. O medo de morrer, o medo de sobrar, de não encontrar emprego e uma série de outros medos constituem o foco da reflexão com o intuito de ampliar o debate sobre as iniciativas institucionais dirigidas aos segmentos juvenis.

Abstract Drawing on the results of an ethnographic study and group interviews with young people and social project coordinators from favelasin Rio de Janeiro, this article discusses the association between youth and vulnerabilities and its possible consequences for the reinforcement of negative stereotypes of poor young people through discourses that emphasize self-management. It explores the notion of production of victims as entrepreneurs of their social redemption by promoting reflection on the use of the category involved in crime, disseminated in the common sense as a new form of criminal labeling. The article addresses material and symbolic investments in poor young people, beneficiaries of so-called social projects, reflecting on the maneuvers of meanings that veil the temporality of these initiatives, characterized by moralistic overtones of merit and salvation. The fear of dying or "remaining", of not finding a job, and a series of other fears are the focus of this reflection, which seeks to broaden the debate over institutional initiatives directed at young people.

The pubovesical complex-sparing technique on laparoscopic radical prostatectomy.

INTRODUCTION: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. PRESENTATION: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. RESULTS: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. CONCLUSION: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.

Penile ulcer as a specific clinical manifestation of Waldenstrom's macroglobulinemia.

Waldenstrom's macroglobulinemia is considered a lymphoma by the World Health Organization. Cutaneous lesions, particularly of a specific type, are rare occurring in 5% of patients. What draws attention in this case is the unusual cutaneous clinical manifestation and its location on the genitals, which has not been described in researched literature, therefore imposing differential diagnosis with other etiologies of genital ulcers.

Penile ulcer as a specific clinical manifestation of Waldenstrom's macroglobulinemia

Abstract Waldenstrom’s macroglobulinemia is considered a lymphoma by the World Health Organization. Cutaneous lesions, particularly of a specific type, are rare occurring in 5% of patients. What draws attention in this case is the unusual cutaneous clinical manifestation and its location on the genitals, which has not been described in researched literature, therefore imposing differential diagnosis with other etiologies of genital ulcers.

Water and nutrient productivity in melon crop by fertigation under subsurface drip irrigation and mulching in contrasting soils / Produtividade da água e de nutrientes em melão fertirrigado por gotejamento subterrâneo sob mulching em diferentes tipos de solo

Cropping intensification and technical, economic and environmental issues require efficient application of production factors to maintain the soil productive capacity and produce good quality fruits and vegetables. The production factors, water and NPK nutrients, are the most frequent limiting factors to higher melon yields. The objective of the present study was to identify the influence of subsurface drip irrigation and mulching in a protected environment on the water and NPK nutrients productivity in melon cropped in two soil types: sandy loam and clay. The melon crop cultivated under environmental conditions with underground drip irrigation at 0.20m depth, with mulching on sandy loam soil increased water and N, P2O5 and K use efficiency.

A intensificação dos cultivos e os aspectos técnico-econômicos e ambientais requerem maior eficiência concernente à aplicação dos fatores de produção, visando à manutenção da capacidade produtiva dos solos, à obtenção de hortaliças e de frutos de boa qualidade. Dentre os fatores de produção, a água e os macronutrientes NPK são os que limitam os rendimentos do melão com maior frequência. Este trabalho teve como objetivo identificar a influência do gotejamento subterrâneo e do mulching, em ambiente protegido, na produtividade da água e dos macronutrientes NPK, num cultivo de melão em dois tipos de solo: Latossolo Vermelho Amarelo (franco-arenoso) e Argissolo Vermelho (argiloso). A cultura do melão em ambiente protegido apresentou aumento de eficiência do uso da água e dos macronutrientes NPK com a utilização de irrigação por gotejamento subterrâneo a 0,20m de profundidade, com o uso do mulching e em solo franco-arenoso.

Pure laparoscopic augmentation ileocystoplasty.

INTRODUCTION: Guillain-Barre syndrome is an acute neuropathy that rarely compromises bladder function. Conservative management including clean intermittent catheterization and pharmacotherapy is the primary approach for hypocompliant contracted bladder. Surgical treatment may be used in refractory cases to improve bladder compliance and capacity in order to protect the upper urinary tract. We describe a case of pure laparoscopic augmentation ileocystoplasty in a patient affected by Guillain-Barre syndrome. PRESENTATION: A 15-year-old female, complaining of voiding dysfunction, recurrent urinary tract infection and worsening renal function for three months. A previous history of Guillain-Barre syndrome on childhood was related. A voiding cystourethrography showed a pine-cone bladder with moderate post-void residual urine. The urodynamic demonstrated a hypocompliant bladder and small bladder capacity (190 mL) with high detrusor pressure (54 cmH2O). Nonsurgical treatments were attempted, however unsuccessfully.

Pure laparoscopic radical heminephrectomy for a large renal-cell carcinoma in a horseshoe kidney.

INTRODUCTION: Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. PRESENTATION: A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. RESULTS: The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. DISCUSSION: Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest cancer (11 cm) removed laparoscopically in the context of a horseshoe kidney.

Pure Laparoscopic Radical Heminephrectomy for a Large Renal-Cell Carcinoma in a Horseshoe Kidney

Introduction Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. Results The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. Discussion Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion ...

Lucio's phenomenon: another case reported in Brazil / Fenômeno de Lúcio: mais um caso relatado no Brazil

Lucio's phenomenon is defined as a variant of type 2 leprosy reaction. It is a rare event, occurring in the evolution of leprosy of Lucio and other forms of lepromatous leprosy. It has an exacerbated proliferation of Hansen bacilli in its pathophysiology, which invade blood vessel walls and injure endothelial cells, causing endothelial proliferation and decreasing the vascular lumen. This fact, associated with inflammatory reactions and changes in the coagulation system causes vascular thrombosis, ischemia, infarction and tissue necrosis, leading to the histopathological characteristic of the phenomenon. We report a case of lepromatous leprosy with irregular treatment that developed Lucio's phenomenon. Treatment with multidrug therapy, antibiotics, steroids and thalidomide achieved a favorable outcome.

Define-se o fenômeno de Lúcio como uma variante da reação hansênica do tipo 2. Evento raro, que ocorre na evolução da hanseníase de Lúcio e de outras formas de hanseníase virchowiana. Tem na sua fisiopatologia uma proliferação exacerbada dos bacilos de Hansen, que invadem a parede dos vasos sanguíneos e agridem as células endoteliais, causando proliferação endotelial e diminuição do lúmen vascular, fato este, que associado a reações inflamatórias e a alterações no sistema da coagulação, causa trombose vascular, isquemia, infarto e necrose tecidual, gerando as alterações histopatológicas características do fenômeno. Relatamos um caso de hanseníase virchowiana, com tratamento irregular, que desenvolveu o fenômeno de Lúcio. Recebeu tratamento com poliquimioterapia, antibióticos, corticosteróide e talidomida, evoluindo com desfecho clínico favorável.