Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Thinking outside the box: the interventional surgeon

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Detection of diagnostic and prognostic methylation-based signatures in liquid biopsy specimens from patients with meningiomas.

Recurrence of meningiomas is unpredictable by current invasive methods based on surgically removed specimens. Identification of patients likely to recur using noninvasive approaches could inform treatment strategy, whether intervention or monitoring. In this study, we analyze the DNA methylation levels in blood (serum and plasma) and tissue samples from 155 meningioma patients, compared to other central nervous system tumor and non-tumor entities. We discover DNA methylation markers unique to meningiomas and use artificial intelligence to create accurate and universal models for identifying and predicting meningioma recurrence, using either blood or tissue samples. Here we show that liquid biopsy is a potential noninvasive and reliable tool for diagnosing and predicting outcomes in meningioma patients. This approach can improve personalized management strategies for these patients.

Point-light display: a new tool to improve verb recovery in patients with aphasia? A pilot study.

Some studies have demonstrated that Action Observation (AO) could help patients with aphasia to recover use of verbs. However, the role of kinematics in this effect has remained unknown. The main aim was to assess the effectiveness of a complementary intervention based on the observation of action kinematics in patients with aphasia. Seven aphasic patients (3 males, 4 females) aged between 55 and 88 years participated in the studies. All patients received a classical intervention and an additional, specific intervention based on action observation. This consisted in visualizing a static image or a point-light sequence representing a human action and in trying to name the verb representing the action. In each session, 57 actions were visualized: 19 represented by a static drawing, 19 by a non-focalized point-light sequence, i.e., a point-light display with all dots in white, and 19 by a focalized point-light sequence, i.e., a point-light display (PLD) with the dots corresponding to the main limbs in yellow. Before (pre-test) and after (post-test) the intervention, each patient performed the same denomination task, in which all actions were presented in photographs. The results showed a significant improvement in performance between pre and post-test, but only when the actions were presented in focalized and non-focalized point-light sequences during the intervention. The presentation of action kinematics seems crucial in the recovery of verbs in patients with aphasia. This should be considered by speech therapists in their interventions.

Action observation and motor learning: The role of action observation in learning judo techniques.

Within the theoretical framework of embodied cognition, several experiments have shown the existence of links between action observation and motor learning. Our aim was to assess the effectiveness of an observational learning protocol (action observation training: AOT) of point-light-display (PLD) in judoka. Twenty participants were given 7 days to learn Go-No-Sen. During this time period, all of the participants received conventional kata training consisting of Uchi-komi and Nage-komi (repetition of techniques) on tatami. In addition to this conventional learning, the experimental group watched 5 min of PLD video representing the different kata techniques, whereas the control group watched neutral videos during the same time period. After the learning period, both the qualitative and biomechanical performances on the kata and the transfer abilities were assessed. The results showed better biomechanical performance and transfer ability in the experimental group than in the control group. Therefore, this first experiment suggests that observational learning of PLD may be beneficial for the acquisition of judo techniques. Future experiments will be needed to specify the mechanisms that are involved in this effect.

PLAViMoP database: A new continuously assessed and collaborative 3D point-light display dataset.

It was more than 45 years ago that Gunnar Johansson invented the point-light display technique. This showed for the first time that kinematics is crucial for action recognition, and that humans are very sensitive to their conspecifics' movements. As a result, many of today's researchers use point-light displays to better understand the mechanisms behind this recognition ability. In this paper, we propose PLAViMoP, a new database of 3D point-light displays representing everyday human actions (global and fine-motor control movements), sports movements, facial expressions, interactions, and robotic movements. Access to the database is free, at https://plavimop.prd.fr/en/motions . Moreover, it incorporates a search engine to facilitate action retrieval. In this paper, we describe the construction, functioning, and assessment of the PLAViMoP database. Each sequence was analyzed according to four parameters: type of movement, movement label, sex of the actor, and age of the actor. We provide both the mean scores for each assessment of each point-light display, and the comparisons between the different categories of sequences. Our results are discussed in the light of the literature and the suitability of our stimuli for research and applications.

Representaciones sociales de la discapacidad en personas con enfermedades crónicas y estudiantes de terapia física / Social representations of disability in people with chronic diseases and physical therapy students

Resumen: Objetivo: Analizar las representaciones sociales del concepto "discapacidad" por personas con enfermedades crónicas, que acuden a una clínica de rehabilitación y estudiantes de la carrera en terapia física, con la finalidad de conocer la valoración sociocognitiva de sentido común, desde dos perspectivas complementarias. Materiales y métodos: Trabajo con enfoque mixto, fundamentado desde el paradigma cualitativo. Se usó la teoría de las representaciones sociales desde la orientación estructural de Abric. Los participantes se seleccionaron por muestreo propositivo, contando con la colaboración de 134 personas de México. Las técnicas para recolectar la información fueron listados libres y comparación de pares. Se realizaron análisis procesual y estructural. Resultados: La mayoría de los participantes con enfermedades crónicas basan su representación social en vivencias. El campo de la representación se fija en el cuerpo deteriorado y su interrupción en las actividades de la vida cotidiana. Los estudiantes en terapia física basan su representación en conocimientos del modelo médico para la intervención, además de mostrar un pensamiento crítico en torno a la discapacidad. Conclusiones: Los hallazgos pueden orientar a intervenciones basadas en modelos educativos, que hagan al paciente un agente activo del proceso de recuperación de su salud, para incluirse en el entorno social.

Abstract: Objective: To analyze the social representations of the concept of "disability" by people with chronic diseases who attend a rehabilitation clinic and students of the career in physical therapy, in order to know the commonsense socio-cognitive assessment from two complementary perspectives. Materials and methods: A mixed method approach, based on the qualitative paradigm were use. The theory of social representations were used from the structural orientation of Abric. Participants were selected by purposeful sampling, with the collaboration of 134 people from México. Techniques to collect the information were free list and pairs comparison. Processual and structural analyzes were use. Results: Most participants with chronic diseases base their social representation on experiences. The field of representation fixed on the deteriorated body and its interruption in daily life activities. Students in physical therapy base their representation on knowledge of the medical model for intervention, in addition to showing critical thinking regarding disability. Conclusions: The findings can guide interventions based on educational models that make the patient an active agent in the process of recovering their health, to be included in the social environment.

The Added Value of Point-Light Display Observation in Total Knee Arthroplasty Rehabilitation Program: A Prospective Randomized Controlled Pilot Study.

Background and Objectives: The present study aimed to assess the potential benefit of the observation of rehabilitation-related point-light display in addition to a conventional 3-week rehabilitation program, the objective being to improve functional capacity in patients having undergone total knee arthroplasty. Materials and Methods: Patients randomized in the control group had conventional rehabilitation treatment with two sessions per day 5 days a week of physical therapy (90 min), whereas patients in the experimental group had a program of conventional rehabilitation combined with a point-light display observation two times per day (5 min) and 3 days a week. Results: The patients of both groups had improved their performances by the end of the program, and the pre- and post-test improvement were superior for the experimental group over the control group concerning the total WOMAC score (p = 0.04), the functional WOMAC score (p = 0.03), and correct recognition of point-light displays (p = 0.003). Conclusions: These findings provide new insight favoring systematic point-light display observation to improve functional recovery in patients with total knee arthroplasty.

Impacto da pandemia por COVID-19 em centro de referência em cirurgia cardiovascular / Impact of the COVID-19 pandemic in a cardiovascular surgery referral center

INTRODUÇÃO: O primeiro caso de infecção causado pela COVID-19 foi primeiramente reportado em Wuhan, China, em meados de dezembro 2019. Desde então, a infecção tomou proporções globais, afetando mais de 200 países. A presença de doença cardiovascular é fator de risco frequentemente observado nos pacientes acometidos pela COVID-19 associado a altas taxas de mortalidade e morbidade. MÉTODOS: Trata-se de um estudo observacional, transversal, retrospectivo, a fim de avaliar o impacto no número de procedimentos cirúrgicos em centro de referência nacional em cirurgia cardiovascular. Foram comparados os números absolutos de cirurgia de revascularização miocárdica, troca ou plastia valvar, correção de aneurismas de aorta, transplante cardíaco e cirurgias para correção de patologias congênitas entre 2019 (Janeiro ­ Dezembro) e 2020 (Janeiro ­ Dezembro). RESULTADOS: Em 2019, foram realizados 1383 procedimentos, dentre os quais, 591 cirurgias de revascularização miocárdica isolada e associadas à aneurismectomia, correção de comunicação interventricular e troca valvar, 359 plastia ou trocas valvares múltiplas ou isoladas. Por outro lado, em 2020, foram realizados 966 procedimentos cirúrgicos, entre os quais, 414 coronarianos, 225 valvares, 241 congênitos, 75 correções de aneurisma ou dissecção de aorta e 11 transplantes cardíacos. Houve uma redução global de 30,1%, na análise exclusiva da cirurgia de revascularização miocárdica, a redução foi de aproximadamente 29,9%. CONCLUSÃO: Muitos questionamentos ainda permanecem no cenário pós-pandemia, a adaptação dos serviços cirúrgicos à abordagem destes pacientes assim como as complicações inerentes da infecção por COVID-19 em consonância àquelas da doença cardiovascular demandarão mais estudos a fim de esclarecer tantos pontos.

Estratégia alternativa para correção de anel vascular com artéria subclávia direita aberrante / Alternative strategy for vascular ring repair with aberrant right subclavian artery

INTRODUÇÃO: Os anéis vasculares, consistem em uma anomalia da embriologia do arco aórtico. É uma doença rara, que atinge menos de 1% das doenças estruturais congênitas. Os anéis, classificam-se em completos e incompletos, a depender da estruturas que circundam a traquéia e o esôfago. A maioria dos pacientes podem ser assintomáticos, contudo quando sintomáticos, costumam apresentar estridores ou disfagia leve á grave, devendo investigar-se com angiotomografia de tórax helicoidal (angio tc), método de escolha para o delineamento anatômico preciso para programação adequada da abordagem cirúrgica. MÉTODO: Paciente 11 meses, sexo feminino, peso de 9 kg, com história prévia de doença do refluxo gastroesofágico, apresentando nos últimos meses disfagia á líquidos, com piora progressiva. Internada, o esofagograma evidenciou banda vascular compatível com anel vascular. O ecocardiograma transtorácico, demonstrou persistência do canal arterial e sugeriu a artéria subclávia direita (ASD)aberrante. (Figuras 1 e 2) Prosseguindo a investigação, realizou-se angio tc com resultado de arco aórtico a esquerda (AAE) com origem anômala ASD aberrante na porção proximal da aorta descendente com trajeto retroesofágico promovendo compressão extrínseca importante deste. Paciente submetido a torocotomia a esquerda, exposição da aorta e identificação dos elementos anatômicos. Optado por secção e sutura do canal arterial. Em seguida, realizado liberação completa de aderências sobre traquéia e esôfago prosseguindo-se com pexia de aorta em pleura parietal deixando-a aberta para evitar que as aderências causem novas compressões, a seguir efetivou-se torocostomia em selo d'água. RESULTADO: No pós operatório não houve intercorrências, e devido uma boa evolução recebeu alta com alimentação balanceada, inclusive com ingestão de alimentos sólidos. CONCLUSÃO: Os sintomas de disfagia ou estridores em lactantes é um desafio ao diagnóstico. A evolução dos exames de imagens cardíacos possibilita ao cirurgião melhores técnicas e diminuição da morbimortalidade. Assim sendo, somente com a ligadura do canal arterial, além de pexia de aorta foram suficientes para uma boa evolução dessa doente sem a secção e reimplante da ASD, como na maioria das literaturas preconizam. Essa estratégia foi optado devido ao acompanhamento rigoroso da paciente ambulatorialmente, demonstrando que mesmo em casos raros novas técnicas cirúrgicas devem ser encorajadas.

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis.

BACKGROUND: This study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. METHODS: A total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. RESULTS: Most patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, ≥ 1 or high dose vasopressors and blood glucose. CONCLUSIONS: Some DMR variables were associated with DGF, suggesting a potential impact of variables reflecting poor clinical and hemodynamic status on the incidence of DGF.

The SLC6A3 3'-UTR VNTR and intron 8 VNTR polymorphisms association in the time estimation.

OBJECTIVE: The present study investigated the association of 3'-UTR VNTR and intron 8 VNTR polymorphisms with a time estimation task performance. MATERIALS AND METHODS: One hundred and eight men in a Brazilian Northeast population (18-32 years old) participated in the experiment. The 3'-UTR VNTR and intron 8 VNTR polymorphisms were associated alone and combined to absolute error (AE) and relative error (RE) in a time estimation task (target duration: 1 s, 4 s, 7 s and 9 s). RESULTS: We found an association of the behavioral variable with intron 8 VNTR for the time intervals of 1 s and 9 s (p < 0.001) and polymorphisms combinatorial effect for 1 s (p ≤ 0.05). CONCLUSION: The intron 8 VNTR polymorphism and the combinatorial effect can modulate the time estimate in the domain of supra seconds, and thus our study indicates a role of the dopamine transporter in the neurobiological areas related to the time intervals judgment.

Redes sociales virtuales y Salud. Una experiencia participativa sobre la enfermedad renal crónica / Virtual social networks and Health. A participatory experience about chronic kidney disease / Redes sociais virtuais e Saúde. Uma experiência participativa sobre a doença renal crônica

Día tras día aumenta la presencia de las redes sociales virtuales en el campo sanitario; sin embargo, pocos autores reportan los avances y dificultades que enfrentan al usarlas. Realizamos un trabajo participativo en Guadalajara, México utilizando dichas redes en cuatro proyectos sobre la enfermedad renal: una investigación, un canal en YouTube, un libro digital y una página en Facebook. Académicos, enfermos, familiares y asociaciones participaron en el proceso. Obtuvimos la información mediante triangulación metodológica e hicimos análisis de contenido. Según nuestros resultados, destaca el análisis del panorama hispanoamericano sobre este tema, la difusión del trabajo colaborativo a la población general y la diversidad de usos de las redes sociales por individuos enfermos. Concluimos que se requiere continuar esta línea de trabajo para ampliar su potencial en el campo sanitario, mediante la colaboración de académicos y otros actores sociales.

Virtual social networks are increasingly present in the health field; however, few authors report the advances and difficulties related to their use. A participatory study using such networks was conducted in Guadalajara, Mexico. Four projects involving kidney disease were implemented: a survey, a YouTube channel, an e-book, and a Facebook page. Students, patients, family members, and associations participated in the process. Information was obtained through method triangulation and content analysis. The findings of this study highlight the analysis of the Hispanic-American perspective on this theme, the diffusion of the collaborative work to the population, and the diversity of uses of social networks by sick individuals. The study concluded that it is necessary to continue this line of work in order to expand its potential in the health field through the collaboration of students and other social actors.

Dia a dia, a presença de redes sociais virtuais aumenta no campo da saúde; no entanto, poucos autores relatam os avanços e as dificuldades que enfrentaram ao usá-las. Realizamos um trabalho participativo em Guadalajara, México, usando tais redes. Implementamos quatro projetos sobre a doença renal: uma pesquisa, um canal no YouTube, um livro digital e uma página no Facebook. Acadêmicos, pacientes, familiares e associações participaram do processo. Obtivemos informações através da triangulação de métodos e análise de conteúdo. De acordo com nossos resultados, destaca-se a análise do panorama hispano-americano sobre esse tema, a difusão do trabalho colaborativo para a população e a diversidade de usos das redes sociais por indivíduos doentes. Concluímos que é necessário continuar esta linha de trabalho para expandir seu potencial no campo da saúde e através da colaboração de acadêmicos e outros atores sociais.

US-GUIDED PERCUTANEOUS CORE LIVER BIOPSY: ANALYSIS OF 171 CASES FROM A SINGLE ONCOLOGY SERVICE.

BACKGROUND: Though strongly suggestive of metastasis, focal lesions on liver scans of oncological patients require histological confirmation for the prescription of adequate treatment. OBJECTIVE: To evaluate the safety and efficacy of US-guided percutaneous core liver biopsy. METHODS: Descriptive, cross-sectional study based on secondary data from 171 patients submitted to US-guided percutaneous core liver biopsy at the diagnostic radiology service of the Ceará Cancer Institute (ICC, Brazil) between February 2010 and March 2015. Quantitative data were expressed in absolute numbers or percentages, with emphasis on the rate of complications observed within six hours after the procedure. RESULTS: The overall accuracy was 96.4%. The overall rate of complications was 2.3%, three quarters of which was due to hemorrhage. Age over 50 years was positively associated with accuracy. No deaths occurred within the period of observation. CONCLUSION: Our findings support the claim that the use of thick biopsy needles improves diagnostic accuracy. The few complications observed were non-lethal and predominantly hemorrhagic.

Biópsia percutâneas de lesões hepática guiada por ultrassonografia: análise de 171 casos de um único centro oncológico / Us-guided percutaneous core liver biopsy: analysis of 171 cases from a single oncology service

ABSTRACT BACKGROUND: Though strongly suggestive of metastasis, focal lesions on liver scans of oncological patients require histological confirmation for the prescription of adequate treatment. OBJECTIVE: To evaluate the safety and efficacy of US-guided percutaneous core liver biopsy. METHODS: Descriptive, cross-sectional study based on secondary data from 171 patients submitted to US-guided percutaneous core liver biopsy at the diagnostic radiology service of the Ceará Cancer Institute (ICC, Brazil) between February 2010 and March 2015. Quantitative data were expressed in absolute numbers or percentages, with emphasis on the rate of complications observed within six hours after the procedure. RESULTS: The overall accuracy was 96.4%. The overall rate of complications was 2.3%, three quarters of which was due to hemorrhage. Age over 50 years was positively associated with accuracy. No deaths occurred within the period of observation. CONCLUSION: Our findings support the claim that the use of thick biopsy needles improves diagnostic accuracy. The few complications observed were non-lethal and predominantly hemorrhagic.

RESUMO CONTEXTO: Lesões focais nos exames de imagem do fígado em pacientes oncológicos, embora sejam achados fortemente sugestivos de envolvimento metastático, permanece a necessidade de confirmação histológica, a fim de que se institua uma terapia apropriada. OBJETIVO: Verificar a segurança e a eficácia do procedimento de biópsia hepática percutânea guiada por ultrassom, realizado pelo serviço de Radiologia e Diagnóstico por Imagem do Instituto do Câncer do Ceará (ICC). MÉTODOS: Estudo transversal, descritivo, baseado em dados secundários de 171 pacientes, submetidos a biópsias hepáticas percutâneas, guiadas por ultrassonografia, realizadas no ICC, de fevereiro de 2010 a março de 2015. Os dados quantitativos obtidos foram apresentados em forma de números absolutos ou percentuais, com ênfase nas taxas de complicações, ocorridas nas primeiras seis horas de observação hospitalar. RESULTADOS: A acurácia geral foi de 96,4%. Encontramos uma taxa global de complicações de 2,3%, sendo que 75% delas foram de natureza hemorrágica. Não verificamos a ocorrência de óbitos dentro do período de observação pós-biópsia. CONCLUSÃO: A utilização de agulhas calibrosas, parece, de fato, estar relacionada à melhoria na acurácia diagnóstica, com baixas taxas de complicações, sobretudo as hemorrágicas, contudo não letais. No presente trabalho, a idade mostrou-se um fator modificador da acurácia.

Low-frequency rTMS in the superior parietal cortex affects the working memory in horizontal axis during the spatial task performance.

Spatial working memory has been extensively investigated with different tasks, treatments, and analysis tools. Several studies suggest that low frequency of the repetitive transcranial magnetic stimulation (rTMS) applied to the parietal cortex may influence spatial working memory (SWM). However, it is not yet known if after low-frequency rTMS applied to the superior parietal cortex, according to Pz electroencephalography (EEG) electrode, would change the orientation interpretation about the vertical and horizontal axes coordinates in an SWM task. The current study aims at filling this gap and obtains a better understanding of the low-frequency rTMS effect in SWM. In this crossover study, we select 20 healthy subjects in two conditions (control and 1-Hz rTMS). The subjects performed an SWM task with two random coordinates. Our results presented that low-frequency rTMS applied over the superior parietal cortex may influence the SWM to lead to a larger distance of axes interception point (p < 0.05). We conclude that low-frequency rTMS over the superior parietal cortex (SPC) changes the SWM performance, and it has more predominance in horizontal axis.

Modelos de percepção do tempo: um novo paradigma para o fisioterapeuta / Time perception models: a new paradigm for the physical therapist

A percepção do tempo é subjetiva e relativa, além de modulada por aspectos neurofuncionais como a emoção, memória e atenção, e está alterada em algumas patologias neuropsiquiátricas. Entretanto, ainda existe muita discussão sobre quais modelos de percepção do tempo são mais aceitáveis e como estão envolvidos nas doenças neurológicas. Desse modo, o conhecimento do fisioterapeuta sobre a percepção do tempo e seus modelos é um fator que pode direcionar ao tratamento do paciente, pois há uma ativação de áreas corticais na percepção do tempo que também são envolvidas na motricidade. Um modelo geral de processamento de informação temporal deve comportar um oscilador, acumulador e comparador dos dados obtidos com a memória. No entanto, as bases neurofisiológicas dos mecanismos de percepção do tempo ainda não são totalmente determinadas, existindo modelos que apontam a existência de um mecanismo neural único ou a de vários dispositivos especializados em diferentes escalas. Embora as mudanças na percepção do tempo não caracterizem uma doença, diversos comprometimentos neurológicos podem acometer a percepção temporal. Apesar dos esforços não se pode concluir sobre quais áreas desempenham a função temporizadora, apenas inferir por meio de experimentos realizados em animais e humanos. (AU)

The time perception is subjective, relative and modulated by neurofunctional aspects such as emotion, memory and attention. This is altered in some neuropsychiatric disorders. However, there is still much debate about which time perception models are more acceptable and how they are involved in neurological diseases. Thus, the physical therapist knowledge of time perception and its models is a factor that can direct the patient treatment, as there is activation in cortical areas which are also involved in motor function. A general model temporal information processing must contain an oscillator, accumulator and comparator data obtained from the memory. However, the neurophysiology of time perception mechanisms are still not fully determined, models exist which indicate the existence of a single neural mechanism or various specialized devices with different scales. Although the change in the time perception does not characterize a disease, various neurological impairments can affect time perception. Despite efforts cannot conclude on areas which perform the timer function, only inferred through performed in animal and human experiments. (AU)

Giant retroperitoneal myelolipoma: case report and literature review / Mielolipoma gigante em retroperitônio: relato de caso e revisão da literatura

Adrenal myelolipomas are unusual benign tumors with an average age of 60 years at onset, often associated with adrenal gland. A 63-year-old female presenting with abdominal discomfort and a large expanding mass in retroperitoneum occupying the right hemiabdomen, with extrinsic compression of adjacent organs, underwent tumor resection. Macroscopic examination of the surgical specimen showed a large yellowish homogeneous lesion with areas of hemorrhage, covered by a thin fibrous capsule. Microscopic analysis revealed a neoplasm composed of mature adipocytes permeated by hematopoietic tissue. There was residual adrenal cortex around the lesion.

Mielolipomas são tumores benignos pouco comuns, com média de incidência de 60 anos, frequentemente associados à glândula adrenal. Relata-se caso de paciente do sexo feminino de 63 anos que apresentava quadro clínico de desconforto abdominal e volumosa formação expansiva em retroperitônio, ocupando hemiabdômen direito com compressão extrínseca de órgãos adjacentes, sendo submetida à ressecção tumoral. A análise macroscópica da peça cirúrgica mostrou volumosa lesão homogênea amarelada com áreas de hemorragia, recoberta por fina cápsula fibrosa. A análise microscópica revelou neoplasia constituída por adipócitos maduros permeados por tecido hematopoiético, notando-se cortical da suprarrenal residual na periferia da lesão.

Comparacion de aptitud de aforadores con aplicacion practica en El Paso / sss

Se ha logrado realizar un inventario de los aforados mas conocidos, comparar las ventajas y desventajas de estos e identificar el mas adecuado para su utilizacion en el area de aplicacion. Con la construccion de estos aforadores se lograra una mejor distribucion del agua y se podra distinguir las aguas provenientes de ls diferentes sistemas de riego. Se podran controlar los caudales sumistrados a cada sistema de riego en especial cuando existen robos de agua en los tramos intermedios a los puntos definidos en la zona de estudio...