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Purpose: Despite the advances of modern operating rooms, surgeons often experience work environments that rival those of industrial workers with regard to the risk of musculoskeletal (MSK) injuries or disorders. Such injuries may result in loss of hours, decreased surgical volume, or premature retirement. This study aimed to investigate the prevalence and impact of MSK injuries among Canadian plastic surgeons and trainees. Methods: A cross-sectional, online survey was disseminated among Canadian plastic surgeons, defined as those registered as members of the Canadian Society of Plastic Surgeons, the Royal College of Physicians and Surgeons of Canada, or Plastic Surgery Residents. Results: This survey was disseminated to 604 Canadian plastic surgeons, fellows, and residents, of whom 139 responded (response rate 23.0%). Of the responders, 49.6% were male, 23.0% were >35 years of age, and 46.1% had been in practice for >10 years. The majority (72.7%) of respondents endorsed experiencing MSK symptoms after operating. Moreover, 18.7% of respondents felt their MSK symptoms had direct consequences on their performance as a surgeon. When MSK symptoms were reported to department heads, system change was only seen 44.4% of the time. Unsurprisingly, neck (76.2%), back (72.2%), and shoulders (48.5%) were the areas of pain most reported. Exercise was not shown to significantly reduce the impact of MSK symptoms resulting from operating ( P = .06). Conclusions: Musculoskeletal symptoms are common among plastic surgeons and directly impact the performance of a large proportion of surgeons. Besides traditional efforts to reinforce good posture while operating, best practice policies and operating room optimization with regard to ergonomics are warranted.

In this article we propose a case study and the analysis of its results. It consists of an intervention on the Municipal School of Early Childhood Education Vila Jardim in Santa Maria, on the state of Rio Grande do Sul. The main objective was to introduce computational knowledge to needy children and also to stimulate their creativity and interest in computing. The study took place inside the school itself, with 17 students from five to six years of age, at the computer lab. In order to make it possible, maintenance was carried out on the equipment and changes in the layout of the room had to be made in order to provide an environment conducive to the construction of learning for the children.

Durante a trajetória acadêmica, os alunos nem sempre conseguem estudar todos os assuntos de seu interesse acadêmico participando apenas das aulas ordinárias do curso. Devido a isso, é importante que os alunos tenham uma forma de se reunir por conta própria para entrar em contato com áreas de conhecimento de interesse dos mesmos. Isso é possível através de grupos de estudo discentes, onde alunos possam compartilhar conhecimento e motivar uns aos outros. Este artigo apresenta uma análise acerca de um estudo realizado com alunos do curso de Ciência da Computação.

Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory, non-infectious arteriopathy in middle-aged patients that tends to affect medium-sized splanchnic arteries typically leading to dissecting aneurysms which in case of rupture have a high mortality. Treatment options include watchful waiting and endovascular or surgical intervention. There are no official treatment guidelines and to the best of our knowledge, there has not been any report of extensive exclusion of multiple splanchnic vessel regions in affected patients to date. We retrospectively examined the outcome of extensive splanchnic embolization in four patients suffering from SAM between 2011 and 2016 with follow-up periods of up to 7 years. One patient presented with abdominal pain due to rupture of aneurysms of the pancreaticoduodenal arcade, one with abdominal pain due to dissection, and two were clinically asymptomatic but displayed rapidly progressing disease over the course of 12 months. All patients were treated with complete exclusion of the diseased vessel segments by coiling all branches to and from the diseased segment. In three cases the main hepatic artery was excluded completely. In one case, the complete vascular bed of the celiac axis was excluded by coiling the distal vessel branches and placing a stent graft over the orifice of the celiac trunk. During a follow-up period of a minimum of 2 and a maximum of 7 years after intervention, there were no immediate or long-term complications except for a temporary arterio-portal fistula. Interestingly, no new diseased areas of SAM were detected afterwards. Extensive endovascular exclusion of the entire diseased arterial segment with coils seems to be a safe and effective treatment option in patients with SAM presenting with ruptured or rapidly growing aneurysms. Provided that patients have normal liver function and proper portal venous flow, risk of hepatobiliary complications seems to be low even after extensive embolization. · An asymptomatic SAM can be followed up.. · In case of disease progression or suspicion of aneurysm rupture, an endovascular approach is indicated where the whole pathological vessel bed should be excluded with coils.. · It seems that exclusion of even extensive vessel areas is tolerated..· Najafi A, Sheikh GT, Binkert C. Extensive Embolization of Splanchnic Artery Aneurysms due to Segmental Arterial Mediolysis. Fortschr Röntgenstr 2019; 191: 1010 - 1014.ZIEL: Die segmentale arterielle Mediolyse (SAM) ist eine seltene, nicht-atherosklerotische, nicht-inflammatorische und nicht-infektiöse Arteriopathie des mittleren Lebensalters, die vorwiegend mittelgroße Viszeralarterien betrifft und typischerweise zu dissezierten Aneurysmata führt, welche im Falle einer Ruptur mit einer hohen Mortalität einhergehen. Als Therapieoptionen kommen in Frage das „watchful waiting“, eine endovaskuläre oder eine chirurgische Intervention. Zurzeit existieren keine offiziellen Richtlinien. Unseres Wissens nach existieren keine Untersuchungen über ausgedehnte Embolisationen mehrerer Viszeralgefäße in dieser Patientengruppe. Wir haben retrospektiv das Resultat extensiver viszeraler Embolisationen bei vier Patienten zwischen 2011 und 2016 untersucht mit Langzeit Follow-Up von bis zu 7 Jahren. Ein Patient präsentierte sich mit Ruptur von Aneurysmen der pancreatico-duodenalen Arkade, ein Patient mit dem Bild eines akuten Abdomens infolge einer Dissektion und zwei Patienten waren asymptomatisch. Die drei Letztgenannten zeigten unter engmaschiger Verlaufskontrolle (bis 12 Monate) einen Progress. Alle Patienten wurden endovaskulär behandelt, wobei jeweils das gesamte erkrankte Versorgungsgebiet, sowohl zuführende als auch abführende Gefäße, mittels Coils ausgeschaltet wurde. In drei von vier Fällen wurden alle hepatischen Arterien gecoilt. Bei einem Patienten wurde das gesamte Stromgebiet des Truncus coeliacus ausgeschaltet mittels Coiling der distalen Gefäße und Stentgraft des Truncusabgangs. Post-interventionell zeigten sich nach einem Follow-Up-Intervall von 2 bis 7 Jahren bis auf eine temporäre arterio-portale Fistel keine weiteren Kurzzeit- oder Langzeitkomplikationen. Interessanterweise entwickelten sich zudem nach dem akuten Krankheitsschub keine neuen Aneurysmata. Das endovaskuläre Ausschalten auch größerer viszeraler Versorgungsgebiete scheint eine sichere und effektive Behandlungsoption bei Patienten mit rupturierter oder progredienter SAM zu sein. Unter der Voraussetzung einer normalen Leberfunktion mit regelrechtem portalvenösem Fluss dürfte die hepatobiliäre Komplikationsrate, auch nach extensiver Embolisation, gering sein.· Eine asymptomatische SAM kann primär beobachtet werden.. · Bei Größenprogredienz der Aneurysmata oder Verdacht auf Ruptur ist eine endovaskuläre Therapie angezeigt, dabei soll das gesamte pathologische Gefäßgebiet mit Coils ausgeschaltet werden.. · Es scheint, dass auch der Ausschluss größerer Gefäßareale toleriert wird..· Najafi A, Sheikh GT, Binkert C. Extensive Embolization of Splanchnic Artery Aneurysms due to Segmental Arterial Mediolysis. Fortschr Röntgenstr 2019; 191: 1010 – 1014.

Diferentes salinidades (15, 20, 25 e 30‰) e temperaturas (20 e 25 ± 1°C) foramavaliadas para determinar as melhores condições de crescimento emNannochloropsis oculata e Isochrysis galbana durante 14 dias. Culturas com 10 diasde idade foram utilizadas como inóculo (1 x 10⁴ cells mL‾1) em meio F/2 de Guillardmodificado, iluminadas continuamente por 6 lâmpadas de led (2000Lm). Concluiu-seque tanto a Nannochloropsis sp. quanto a Isochrisis sp. conseguiram crescer entre assalinidades 15‰ e 30‰ nas duas temperaturas avaliadas. Para ambas algas ocrescimento foi melhor quando cultivada a 25°C.

Resection elbow arthroplasty is a salvage procedure indicated most commonly in the presence of refractory joint infection, typically in patients with an existing total elbow arthroplasty (TEA). Elbow resection is uncommonly performed or required, and therefore scant literature exists as to the outcome or usefulness of this procedure. Outcome studies suggest that elbow resection arthroplasty is reliable in eradicating elbow prosthetic infections, in reducing pain, and that the functional results of a “flail arm” following resection may in fact outweigh the reinfection risk with prosthetic reimplantation.

Background The standard approach for crossing peripheral CTOs is to use a combination of hydrophilic guidewires and catheters. The path is either intraluminally or in most cases at least partially subintimal. This standard approach with a guidewire-tip as leading point (“wire first”) to cross CTOs has a success rate of about 80%. We hypothesize that a “catheter first” approach, using the catheter alone for the entire recanalization till re-entering the vessel is less traumatic and might lead to a longer intraluminal recanalization due to a softer leading point. Based on this assumption we analyzed the success and duration of this approach with a gradual step-up approach from catheter tip to guidewire front-end to guidewire back-end. To the best of our knowledge, no studies measuring the time of recanalization of lower extremity CTOs using conventional devices were published yet. Results Data of 46 consecutive chronic total iliaco-femoro-popliteal occlusions in 43 symptomatic patients treated by percutaneous transluminal angioplasty were collected prospectively between May 1st 2014 and June 30th 2016 and evaluated retrospectively. Chronic occlusion was defined as clinical symptoms or imaging features lasting more than 1 month. Patient age and gender, diabetes status, localization of occlusion, occlusion length, duration of symptoms, severity of vessel calcification, and recanalization time were assessed. Technical success was defined as placement of a catheter beyond the distal end of the lesion into the true lumen, confirmed by contrast injection. All 46 CTOs were successfully recanalized. In 22 cases (47.8%) recanalization was successful with the catheter tip only without the use of a guide wire. In 17 cases (36.9%) the guide wire was used in addition to the catheter. Localization of occlusion did not have an effect on the recanalization technique (p = 0.915). The mean rank for length of occlusion was not significant for different recanalization techniques (p = 0.095). The success rate for the catheter only approach was lower for higher grades of calcification (p = 0.008). There was no correlation between time of recanalization and length of occlusion (Pearson’s r = 0.004; adjusted R square = − 0.024; p = 0.980), diabetes (p = 1.000), sex (p = 0.244), or grade of calcification (p = 0.621). Recanalization time is significantly right-skewed with most recanalizations being successful under 30 min. Conclusion This “catheter first” approach is somewhat contradictory to the prevailing dogma of “wire first”. The concept to use the catheter to start a recanalization is well known, but to perform the entire recanalization including the re-entry seems possible and potentially less traumatic, likely leading to a longer intraluminal course. Our data shows that recanalization of occluded lower extremity arteries between the aortic bifurcation and the popliteal artery can be achieved in the majority of cases (84.7%) solely by using an angled angiographic catheter +/− glide wire. We suggest a “5 min – 15 min – 30 min” rule on how long to attempt each recanalization technique. More precisely, we suggest trying 5 min with the catheter alone, then 10 min with the soft end of the guidewire and then switching to the stiffer back-end of the guidewire for another 15 min.

To assess the detectability and frequency of the different types of utero-ovarian anastomosis, the correlation between type of anastomosis and ovarian failure after UAE, as well as the impact of coiling as a strategy for the prevention of ovarian failure. We retrospectively studied a population of 92 women treated with uterine artery embolization at our institution between 2007 and 2017. Utero-ovarian anastomoses were categorized on angiographic sequences by two radiologists based on the classification published by Razavi et al. (Radiology 224(3):707–712, 2002), and Cohen’s kappa was calculated. Ovarian failure was defined as an increase in serum FSH above 27 mIU/ml three months after embolization. Out of a total of 184 anastomoses, 27% were classified as type Ia, 45% as type Ib, 1% as type II and 24% as type III. Three percent of anastomoses could not be determined. There was very good inter-observer reliability on the classification of utero-ovarian anastomoses (κ = 0.847). Ovarian failure occurred in six out of 92 women (7%). Each had at least one type Ib (n = 4) or type III (n = 1) anastomosis, with the exception of one patient in whom the type of anastomosis could not be determined. All women presenting with ovarian failure were 45 years of age or older. No patient with protective coiling developed ovarian failure. Utero-ovarian anastomoses are more common than previously expected and can be reliably classified with very good inter-observer reliability. Patients with type Ib and type III anastomoses carry the risk of ovarian failure after uterine artery embolization. Protective coiling seems to be an adequate strategy for avoiding ovarian failure in those types of anastomoses.