Peritoneal sarcoidosis that simulates peritoneal carcinomatosis: a case report.

Sarcoidosis is a multisystem inflammatory disorder of unknown cause characterized by the formation of pleomorphic, non-caseating granulomas with predominantly pulmonary involvement. Although abdominal sarcoidosis represents 30% of extrapulmonary manifestations, peritoneal involvement is extremely rare. We will describe a rare case of peritoneal sarcoidosis simulating carcinomatosis in a young patient with abdominal pain who underwent laparoscopic examination.

La sarcoidosis es un trastorno inflamatorio multisistémico de causa desconocida que se caracteriza por la formación de granulomas pleomórficos, no caseificantes, con afectación predominantemente pulmonar. Aunque la sarcoidosis abdominal representa el 30% de las manifestaciones extrapulmonares, la afectación peritoneal es extremadamente rara. Describiremos un caso poco frecuente de sarcoidosis peritoneal simulando carcinomatosis en una paciente joven con dolor abdominal sometida a exploración laparoscópica.

Jejunal perforation secondary to kick during kick-boxing practice: laparoscopic management / Perforación yeyunal secundaria a patada durante práctica de kick-boxing: Manejo laparoscópico

Abstract Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.

Resumen La lesión intestinal en un entorno deportivo es infrecuente con pocos casos comunicados. Un varón de 30 años consultó por dolor abdominal generalizado posterior a un traumatismo abdominal cerrado secundario a la práctica de kick-boxing. Una tomografía computarizada de abdomen y pelvis reveló líquido libre tanto en el espacio parietocólico como en la bolsa rectovesical, con neumoperitoneo perihepático. Se indicó laparoscopia exploradora con cirugía de rafia intestinal. El diagnóstico de las lesiones del intestino delgado es difícil, lo que provoca un retraso en el tratamiento y un aumento de la mortalidad y la morbilidad.

Jejunal perforation secondary to kick during kick-boxing practice: laparoscopic management.

Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.

La lesión intestinal en un entorno deportivo es infrecuente con pocos casos comunicados. Un varón de 30 años consultó por dolor abdominal generalizado posterior a un traumatismo abdominal cerrado secundario a la práctica de kick-boxing. Una tomografía computarizada de abdomen y pelvis reveló líquido libre tanto en el espacio parietocólico como en la bolsa rectovesical, con neumoperitoneo perihepático. Se indicó laparoscopia exploradora con cirugía de rafia intestinal. El diagnóstico de las lesiones del intestino delgado es difícil, lo que provoca un retraso en el tratamiento y un aumento de la mortalidad y la morbilidad.

Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery.

BACKGROUND: Laparoscopic surgery techniques have been demonstrated to provide massive benefits to patients. However, surgeons are subjected to hardworking conditions because of the poor ergonomic design of the instruments. In this article, a new ergonomic handle design is presented. This handle is designed using ergonomic principles, trying to provide both more intuitive manipulation of the instrument and a shape that reduces the high-pressure zones in the contact with the surgeon's hand. MATERIALS AND METHODS: The ergonomic characteristics of the new handle were evaluated using objective and subjective studies. The experimental evaluation was performed using 28 volunteers by means of the comparison of the new handle with the ring-handle (RH) concept in an instrument available on the market. The volunteers' muscle activation and motions of the hand, wrist, and arm were studied while they performed different tasks. The data measured in the experiment include electromyography and goniometry values. RESULTS: The results obtained from the subjective analysis reveal that most volunteers (64%) preferred the new prototype to the RH, reporting less pain and less difficulty to complete the tasks. The results from the objective study reveal that the hyperflexion of the wrist required for the manipulation of the instrument is strongly reduced. CONCLUSIONS: The new ergonomic handle not only provides important ergonomic advantages but also improves the efficiency when completing the tasks. Compared with RH instruments, the new prototype reduced the high-pressure areas and the extreme motions of the wrist.

Accurate estimation of airborne ultrasonic time-of-flight for overlapping echoes.

In this work, an analysis of the transmission of ultrasonic signals generated by piezoelectric sensors for air applications is presented. Based on this analysis, an ultrasonic response model is obtained for its application to the recognition of objects and structured environments for navigation by autonomous mobile robots. This model enables the analysis of the ultrasonic response that is generated using a pair of sensors in transmitter-receiver configuration using the pulse-echo technique. This is very interesting for recognizing surfaces that simultaneously generate a multiple echo response. This model takes into account the effect of the radiation pattern, the resonant frequency of the sensor, the number of cycles of the excitation pulse, the dynamics of the sensor and the attenuation with distance in the medium. This model has been developed, programmed and verified through a battery of experimental tests. Using this model a new procedure for obtaining accurate time of flight is proposed. This new method is compared with traditional ones, such as threshold or correlation, to highlight its advantages and drawbacks. Finally the advantages of this method are demonstrated for calculating multiple times of flight when the echo is formed by several overlapping echoes.

Importância da umidade fetal e serviço de cardiologia pediátrica integrados na mesma estrutura hospitalar / The importance of the pediatric cardiology division and fetal unit being integrated in the same hospital structure

A cardiologia pediátrica vem experimentando inigualável desenvolvimento nos últimos anos. Novas técnicas cirúrgicas e intervencionistas têm propiciado o tratamento neonatal de várias anomalias, cujo prognóstico anteriormente era desfavorável. A cardiologia fetal é parte importante deste crescimento, não apenas pela possibilidade do diagnóstico precoce, como, também, pela abertura de novas opções terapêuticas ainda na vida intrauterina. Esta especialidade tem trazido um novo paciente para dentro do hospital cardiológico, o feto, com todas as suas particularidades, e, em especial, por estar dentro do organismo materno. Por estes motivos, tem sido tendência atual a instituição de uma unidade fetal acoplada ao centro de cardiologia pediátrica, onde procedimentos diagnósticos e terapêuticos podem ser realizados de maneira segura na vida pré-natal e onde o recém-nascido já é trazido ao centro especializado que receberá o tratamento cirúrgico ou intervencionista, desde o momento do parto. Neste artigo, serão discutidas as vantagens e o impacto da unidade fetal na evolução de recém-nascidos portadores de cardiopatias com repercussão hemodinâmica neonatal.

Protótipo de um sistema de gerenciamento de protocolos de câncer colorretal / Management system prototype of colorectal cancer protocols

OBJETIVO: desenvolvimento de um protótipo de sistema de cadastro e controle de protocolos de Câncer Colorretal, com a finalidade de armazenar um conjunto abrangente de dados de forma estruturada para posterior aplicação de métodos de análise inteligente de dados. MATERIAL E MÉTODO: o protótipo foi construído em cinco etapas: análise do domínio de Câncer Colorretal, definição de requisitos básicos (operacionais e informacionais), projeto do sistema, construção do sistema usando tecnologias open source e avaliação do sistema com o apoio de especialistas. RESULTADOS E DISCUSSÃO: durante o desenvolvimento, o protótipo foi avaliado por especialistas quanto à estrutura do conjunto de dados, à coerência de organização das informações, à validade das funcionalidades implementadas e ao atendimento aos requisitos básicos definidos. CONCLUSÃO: de acordo com os especialistas usuários, o desenvolvimento do protótipo completou a primeira etapa do projeto de desenvolvimento de um sistema em nível de 100 por cento de satisfação e, atualmente, está sendo aplicado em cadastros de dados reais. Na próxima etapa será consolidado e implantado o sistema completo, atendendo a requisitos de segurança com suporte a multiusuários.

OBJECTIVE: to develop a prototype of a Colorectal Cancer records management system, aiming to store an embracing structured dataset for later application of intelligent data analysis methods. MATERIAL AND METHOD: the prototype was developed in five stages: Colorectal Cancer domain analysis, definition of basic requirements (operational and informational), system design, system construction using open source technologies and system evaluation supported by domain experts. RESULTS AND DISCUSSION: during development, the prototype dataset structure, coherence of information structure, validity of functions implemented and the attendance to the basic requirements define, were evaluated by domain experts. CONCLUSION: according to the experts evaluation, the prototype development completed the first stage of the project of developing the system with a 100 percent satisfaction rate and is now being used into recording real data. In the next stage it will be finished and deployed the complete system, attending to security requirements and multiuser support.

Ultrasonic sensors in urban traffic driving-aid systems.

Currently, vehicles are often equipped with active safety systems to reduce the risk of accidents, most of which occur in urban environments. The most prominent include Antilock Braking Systems (ABS), Traction Control and Stability Control. All these systems use different kinds of sensors to constantly monitor the conditions of the vehicle, and act in an emergency. In this paper the use of ultrasonic sensors in active safety systems for urban traffic is proposed, and the advantages and disadvantages when compared to other sensors are discussed. Adaptive Cruise Control (ACC) for urban traffic based on ultrasounds is presented as an application example. The proposed system has been implemented in a fully-automated prototype vehicle and has been tested under real traffic conditions. The results confirm the good performance of ultrasonic sensors in these systems.

Modelo computacional para o gerenciamento de dados e exames de pacientes para o acompanhamento remoto por meio de conferência multimídia / Computational model for data and patients' exams management for remote follow-up by multimedia conferences

OBJETIVO: Desenvolver um modelo computacional para aquisição, gerenciamento e armazenamento de dados e exames de pacientes, e definir uma arquitetura de conferência multimídia para o acompanhamento remoto de exames. MATERIAIS E MÉTODOS: Definiu-se uma arquitetura computacional para a aquisição de exames a partir de equipamentos hospitalares, e para o armazenamento e gerenciamento de dados e exames de pacientes foram utilizados o servidor de aplicações Jboss, o sistema gerenciador de banco de dados MySQL, o servidor de páginas Apache e o framework Jboss-Seam para o desenvolvimento de aplicações. Para a conferência multimídia, foi aplicado um estudo de caso utilizando a arquitetura Openmeetings. RESULTADOS: Foram definidos modelos computacionais para o gerenciamento consistente e seguro de dados e exames de pacientes e estudou-se uma arquitetura para conferência multimídia. CONCLUSÃO: Os modelos computacionais, o protótipo implementado e a arquitetura de conferência multimídia avaliada poderão ser aplicados em situações reais da área médica, contribuindo para o acompanhamento remoto de pacientes.

OBJECTIVE: To develop a computational model for acquisition, management and storing data and patients' exams, and to define a multimedia conference architecture to remote patients' follow-up. MATERIALS AND METHODS: A computational architecture was defined to acquire exams' information from hospital equipment and to store and manage patients' data and exams using the JBoss application server, the MySql database manager system, the Apache web page server and the Jboss Seam framework for application development. For multimedia conference, a case study using the Openmeetins architecture was performed. RESULTS: computational models intended to the consistent and safe management of data and patients' exams were defined and a multimedia conference architecture was studied. CONCLUSION: The computational models, the prototype developed and the multimedia conference architecture may be applied into real medical situations, contributing for remote patient accompaniment.

Estudo comparativo de modelos computacionais gerados sobre representações de imagens de coloscopia: tecido de mucosa normal VS tecido de mucosa de pólipo cólico / Comparative study of computacional models generated from representations of colonoscopic images: normal mucosal tissues VS mucosal tissues of colic polyp

Objetivo: analisar a qualidade preditiva de modelos computacionais para a diferenciação de tecidos cólicos, construídos a partir da representação de Imagens de Coloscopia (IC) como Matrizes de Co-ocorrência (MC). Materiais e Métodos: os modelos foramconstruídos aplicando técnicas de análise de imagens e de inteligência artificial. Foram utilizadas 67 IC, contendo pólipos, a partir das quais foram extraídas uma imagem da parte de tecido de pólipo e outra de tecido sem pólipo adjacente, totalizando 134 imagens. Para cada imagem, foram construídas MC para diferentes valores do parâmetro distância, D = 1 a 5, e extraídas 11 características de textura.Com essa representação, foram criados cinco modelos computacionais baseados em árvores de decisão. Os modelos foram avaliados utilizando: (a) validação cruzada e (b) tabelas de contingência. Resultados: na análise (a), o modelo de D = 3 apresentou o menor erro médio (22,25% ± 11,85%). Na análise (b), os modelos de D = 1 e 3 apresentaram os melhores valores de precisão. Conclusão: os valores do parâmetro de distância D = 1 e 3 apresentaram os modelos com as melhores qualidades preditivas. Os resultados mostraram que os modelos construídos apresentaram-se promissores para a construção de sistemas computacionais de suporte à decisão.

Purpose: to evaluate the predictive quality of computational models to differentiate colic tissues, based on Cooccorrurence Matrices (MC) representation of Coloscopic Images (IC). Materials and Methods: image analysis and artificial intelligence methods were employed to construct computational models. Sixty seven IC images, containing polyp, were considered in this work, from which a part containing a polypus and another without it were collected given origin to 134 images. For each one of these, different MC were constructed considering five distance parameters (D = 1 to 5) and the extraction of 11 texture characteristics. With this representation, five computational models were generated based on decision trees. These models were evaluated using two techniques: (a) cross-validation and (b) contingency tables. Results: for the (a) analysis, the model with D = 3 presented the smaller average error (22.25% ± 11.85%). For the (b) analysis, models with D = 1 and 3 presented the best precision values. Conclusion: parameters D = 1 and 3 presented models with the best predictive qualities. Results showed that the constructed models were promising to be applied within decision making computational systems.