Bronchobiliary fistula after stenting of biliary duct as the management of iatrogenic bile duct injury during elective cholecystectomy.

BACKGROUND: Bronchobiliary fistula is a rare and complex entity defined by an abnormal communication between the biliary and bronchial systems. The etiopathogenesis is not completely understood, but the most common factors implicated are hepatobiliary tumors, biliary obstruction, iatrogenic damage or trauma. METHODS: Here we present a case of a 69-year-old man that developed a bronchobiliary fistula and a pulmonary abscess after migration of a bile duct stent placed as part of the treatment of an iatrogenic bile duct injury that occurred during elective cholecystectomy. RESULTS: A conservative approach, that included broad-spectrum antibiotic, removal of the stent, and sphincterotomy, was enough for the closure of the fistula and resolution of the symptoms. CONCLUSION: We emphasize the importance of prompt recognition of this entity and a concerted therapeutic strategy to optimize the probability of success, avoiding the destructive consequences of the bile in the pulmonary parenchyma and septic complications.

Neuromuscular and motor patterns in breaststroke technique / Padrões motores e musculares na técnica de bruços

Abstract The aim of this study was to analyze the inter-temporal neuromuscular and motor patterns in breaststroke technique. Five national level male swimmers performed 200 m breaststroke at maximal effort. Electromyography data onbiceps brachii, deltoid anterior, pectoralis major and triceps brachiiwere analysed. The relative duration of active and non-active phase and the average rectified value for the neuromuscular patterns were recorded. The swim bouts were videotaped in sagittal plane with a pair of cameras and the Theme software 5.0 was used toanalyse the detected patterns in each swimmer. The neuromuscular pattern revealed that by the average rectified value the biceps brachiiand triceps brachiiwere increased at the end of the test for swimmers 1 and 5, while biceps brachii. deltoid anteriorand pectoralis majorwere increased for swimmers 2 and 4. Different motor patterns between cycles, and between swimmers were observed.We found similarities between the swimmers, adjusting their style to the technical model. The absence of a neuromuscular pattern for all swimmers could be related to different technical models used by each swimmer, as presented in the motor patterns. These findings suggested that each swimmers adapted their own motor and neuromuscular pattern in a unique and distinct way.

Resumo O objetivo deste estudo consistiu em analisar a relação entre os padrões neuromusculares e motores na técnica do nado de peito. Cinco nadadores masculinos de nível nacional realizaram 200 mnado peito na máxima intensidade.Foram registrados dados de Electromiografia do bicepsbrachii, deltoid anterior, pectoralis major etricepsbrachii. A duração relativa da fase ativa e não ativa e o valor médio retificado dos padrões neuromusculares foram analisados. Os percursos de nado foram gravados no plano sagital e analisados para detectar os padrões motores de cadanadador através do software THÉME software 5.0. Os padrões neuromusculares indicaram, por meio do valor médio retificado que a atividade dos músculos bíceps brachii e tríceps brachii aumentam no final do teste para o nadador 1 e 5, enquanto que o bíceps brachii. deltoid anterior. pectoralis major aumentam para o nadador 2 e 4. Diferentes padrões motores entre ciclos e entre nadadores foram observados, indicando que existem semelhanças entre eles, levando a um ajuste do estilo e modelo técnico de nado. A ausência de um padrão neuromuscular para todos os nadadores poderá estar relacionada com os diferentes modelos técnicos utilizados por cada nadador, como demonstrado nos padrões motores. Esses resultados sugerem que cada nadador adapta o seu padrão motor e muscular de uma forma única e distinta.

Impact on sexual function of surgical treatment in rectal cancer

ABSTRACT Introduction The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients' sexual and urinary function has been recently observed. Aim Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa. Materials and Methods An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery. Discussion All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn't resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor's location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery. Conclusions This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.

Impact on sexual function of surgical treatment in rectal cancer.

INTRODUCTION: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients' sexual and urinary function has been recently observed. AIM: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa. MATERIALS AND METHODS: An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery. DISCUSSION: All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn't resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor's location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery. CONCLUSIONS: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.

Stability of behaviour patterns in the 200m breaststroke / Estabilidade dos padrões comportamentais nos 200m do nado peito

Abstract The aim of this study was to analyse the stability of the breaststroke technique in five elite swimmers in a 200m event using a qualitative analysis. The codification of the behaviour of each swimmer during the execution of 20 cycles was achieved using an ad hoc observational instrument comprised of a system of categories and field formats to detect the behavioural patterns (T-patterns); software was used for identifying the technical behaviour of stable structures. The results showed that the stability behaviour varied depending on the swimmer, as the variations of codes in each round produced distinct configurations to determine the differences between cycles for the same swimmer. It was concluded that the instrument used in this study plays an important role through the existence of stable behaviour in the breaststroke technique. It was also concluded that there are distinct patterns and behaviours between swimmers during each lap of the race.

Resumo O objetivo deste estudo foi analisar a estabilidade da técnica de bruços em cinco nadadores de elite numa prova de 200m usando uma análise qualitativa. A codificação do comportamento de cada nadador durante a execução de vinte ciclos de nado foi alcançado usando um instrumento de observação ad-hoc composto por um sistema de categorias e formatos de campo para detectar os padrões comportamentais (T-patterns); o software foi utilizado para identificar o comportamento técnico de estruturas estáveis. Os resultados indicaram que o comportamento da estabilidade dos nadadores variou de acordo com o nadador, como as variações de códigos em cada ronda produzido configurações distintas para determinar as diferenças entre os ciclos para o mesmo nadador. Concluiu-se que o instrumento utilizado neste estudo desempenha um papel importante, através da existência de um comportamento estável na técnica de nado de peito. Concluiu-se também que existem padrões distintos e comportamentos entre nadadores durante cada percurso de nado.

Observação e caracterização técnica em natação pura desportiva: 200 m bruços / Observation and technical characterization in swimming: 200 m breaststroke

OBJETIVO: Caracterização da técnica de bruços, na relação entre os parâmetros cinemáticos e neuromusculares. MÉTODO: A eletromiografia de superfície (EMG) foi utilizada para analisar a dinâmica da atividade neuromuscular nos músculos peitoral maior (PM), bicípite braquial (BB), tricípite braquial (TB) e deltoide anterior (DA) em 12 nadadores de elite nacional. Foi utilizado um par de câmaras, fornecendo uma projeção dupla a partir de uma câmara subaquática e outra acima da superfície da água, para análise das variáveis cinemáticas: velocidade de nado (VN), frequência gestual (FG) e distância de ciclo (DC) em 200m bruços. RESULTADOS: A VN diminui de 1,41 (0,07) para 1,16 (0,09)m.s-1 (P < 0,05). A DC diminuiu de 2,32 (0,37) para 1,96 (0,24)m, enquanto a FG sofreu um decréscimo de 37,52 (5,16) para 34,40 (3,58) ciclo/min do primeiro percurso de 50m até ao terceiro percurso de 50 m, aumentando ligeiramente no último percurso para 35,82 (3,39) ciclo/min. O lactato sanguíneo aumentou de repouso para o pico de lactato sanguíneo de 1,12 (0,22) para 12,00 (3,23) mmol.L-1. Os resultados de EMG indicaram um aumento da frequência em relação à amplitude para todos os músculos em estudo, exceto para o DA. Correlações negativas foram obtidas entre a frequência e a VN, FG e DC, ou seja, para os músculos BB, TB e PM, verificou-se uma correlação forte entre VN, FG e DC, isto é, à medida que as variáveis cinemáticas aumentam a frequência diminui. As correlações sugerem que a ativação neuromuscular apresenta relação direta com as variáveis cinemáticas, nomeadamente para uma diminuição da frequência, nos músculos BB, TB e PM e para uma elevada amplitude e forte correlação com as variáveis cinemáticas em PM. CONCLUSÃO: A relação entre as variáveis cinemáticas e EMG são determinantes na avaliação da performance em natação pura desportiva, nomeadamente, no suporte na prescrição de exercícios para o aumento da resistência muscular dos músculos envolvidos na técnica de bruços.

INTRODUCTION: Characterization of the breaststroke technique, regarding the relationship between kinematic and neuromuscular parameters. METHOD: Surface electromyographic signals (EMG) were used to analyze the dynamics of neuromuscular activity of the muscles pectoralis major (PM), biceps brachii (BB), triceps brachii (TB) and anterior deltoid (AD), in twelve national elite swimmers. A couple of cameras (an underwater camera and an above the water surface camera) were used to provide a dual projection that permits analysis of kinematic variables (Speed, SF, SL) in the 200 m breaststroke event. RESULTS: Swimming speed decreased from 1.41 (0.07) to 1.16 (0.09) m.s-1(P<0.05). Stroke length decreased from 2.32 (0.37) to 1.96 (0.24) m, while stroke frequency suffered decrease from 37.52 (5.16) to 34.40 (3.58) cycle/min of 1st lap 50 m until the 3rd lap of 50 m, slightly increasing in the last lap to 35.82 (3.39) cycle/min. Blood lactate increased from 1.12 (0.22) to 12.00 (3.23) mmol.L-1. EMG results indicated increase in frequency concerning amplitude for all muscles studied: BB, PM and TB, except for the AD. Negative correlation between speed frequency, SF and SL was obtained, i.e. to the muscles BB, TB and PM there was a correlation between speed, SF and SL, meaning that as the kinematic variables increase, the frequency decreases. The correlations suggested that the neuromuscular activation presents a direct correlation with the kinematic variables, especially for frequency reduction in the BB, TB and PM muscles, and to a high extent and correlation with the kinematic variables in PM. CONCLUSION: The relationship between the kinematic variables and EMG is decisive in the swimming performance evaluation, in training exercises outside the pool to increase muscular endurance of muscles involved in the breaststroke technique.