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Peritoneal adhesions are bridges of fibrous tissue that connect two or more structures, and can cause anatomical and functional changes in organs. Adhesions result from the imbalance between fibrinolysis inhibitors and activators, which are mediated by cytokines. After inflammation, there is an increase in vascular permeability and local fibrin exudation. The aim of this study was to assess adhesiolysis in ewes using laparoscopy after adhesion induction in the uterus, ovary, and adjacent organs using monopolar diathermy. Five ewes were used. For adhesion induction, the ewes underwent laparotomy. A skin incision was performed in the mid-inguinal line, exposing the uterus, ovaries and uterine tubes. The adhesion induction was performed at three points on the right side of the uterus and at three points on the right ovary. Laparoscopic adhesiolysis was performed 15 days after the first surgery. After 30 days, a third procedure was made to evaluate resolution after adhesiolysis. One animal died after the surgery, the necropsy revealed a fistula due to adhesions that resulted in acute peritonitis. Concerning classification, adhesiolysis was impossible in one ewe (25%), partially possible in the reproductive tract, adjacent organs, omentum, and abdominal wall in two ewes (50%), partially possible in reproductive tract in one ewe (25%), and totally possible in none of the ewes. This study shows that monopolar diathermy can induce adhesions. The endo-surgery was only partially effective regarding morbidity, it produced good results as it reduces the occurrence of injuries and promotes clinical improvement by allowing abdominal adhesiolysis. Keywords: Adhesions Treatment. Fibrous Tissue. Laparoscopy. Monopolar Diathermy. Ovary. Resumo As aderências peritoneais são pontes de tecido fibroso que conectam duas ou mais estruturas, podendo causar alterações anatômicas e funcionais em órgãos. As aderências resultam do desequilíbrio entre os inibidores e ativadores da fibrinólise, que são mediados por citocinas. Após a inflamação, ocorre aumento da permeabilidade vascular e exsudação local de fibrina. O objetivo deste estudo foi avaliar a adesiólise em ovelhas por meio de laparoscopia após a indução de aderências no útero, ovário e órgãos adjacentes por meio de diatermia monopolar. Foram utilizadas cinco ovelhas. Para indução de aderências, as ovelhas foram submetidas a laparotomia. Uma incisão na pele foi realizada na linha inguinal média, expondo o útero, ovários e tubas uterinas. A indução da adesão foi realizada em três pontos do lado direito do útero e em três pontos do ovário direito. A adesiólise videolaparoscópica foi realizada 15 dias após a primeira cirurgia. Após 30 dias, um terceiro procedimento foi realizado para avaliar a resolução após adesiólise. Um animal morreu após a cirurgia, a necropsia revelou uma fístula devido a aderências que resultaram em peritonite aguda. Com relação à classificação, adesiólise foi impossível em uma ovelha (25%), parcialmente possível no trato reprodutivo, órgãos adjacentes, omento e parede abdominal em duas ovelhas (50%), parcialmente possível no trato reprodutivo em uma ovelha (25%), e totalmente possível em nenhuma das ovelhas. Nosso estudo mostra que a diatermia monopolar pode induzir aderências. A endocirurgia foi apenas parcialmente eficaz quanto à morbidade, apresentou bons resultados, pois reduz a ocorrência de lesões e promove melhora clínica ao permitir adesiólise abdominal. Palavras-chave: Tratamento de Aderências. Tecido Fibroso. Laparoscopia. Diatermia Monopolar. Ovário.

Uma boa escolha de matriz energética residencial tem grande importância. Na região da Baía de Todos os Santos a energia solar surge como principal alternativa à energia hidrelétrica. Neste trabalho, através de um estudo comparativo, foi estimado o valor de implantação e de consumo de energia em 20 anos em uma edificação residencial real para cada uma das matrizes citadas. A partir dessas, é notável que a adoção da matriz solar em conjunto automação é vantajosa, apresentando benefícios pronunciados em longo prazo, mesmo com custo inicial superior. Em trabalhos futuros, busca-se a análise ambiental e social da mudança energética estudada.

Mold fluxes play an important role in the lubrication and heat transfer control between the mold wall and steel shell during the continuous casting process. To ensure control of the heat transfer, it is necessary to evaluate the crystallinity of mold flux. The casting of peritectic steel commonly uses the mold flux that forms crystalline phases. These phases, in particular the cuspidine (Ca4Si2O7F2), increase resistance to radiation heat transfer, leading the steel to cool slowly and to ensure the production of defect-free products. The purpose of this paper is to create alternative peritectic fluxes obtaining gain due to the use of a cheaper raw material, avoiding the disposition of residues in the environment. Thus, using FactSage® software, new mold fluxes were simulated from a commercial peritectic flux with additions of calcific marble residue, SiO2 and CaF2. From the thermodynamics simulations, three new fluxes were chosen and experimentally developed. In those fluxes, the physical properties such as melting point, break temperature, phases and microstructure were analyzed and compared with the commercial peritectic flux. The measurements using Differential Thermal Analysis (DTA) showed that there was no significant change in the melting point and break temperature. Cuspidine, crystalline phases and dolomite were established in all new samples. By using the thin-film technique, it was possible to observe that the microstructures of the new fluxes obtained were similar to with the commercial one. The presence of acicular grains was the main difference in the sample with highest residue concentration. Keywords: Peritectic mold flux, Calcitic marble, Physical properties, Acicular grains

Folliculosebaceous cystic hamartoma (FSCH) is a cutaneous hamartoma of pilosebaceous origin that usually occurs on the face. We present what we believe is only the second reported case of FSCH of the external auditory canal, and the first in an adult. The patient was a 59-year-old woman who presented with a 4-year history of a firm nodule on the left external auditory canal that had caused hearing loss, pruritus, and pain. The lesion was excised, and histopathologic examination identified infundibular cysts, hyperplasia of the sebaceous lobules, and a large amount of mucin, features that are consistent with FSCH. One year postoperatively, the patient was asymptomatic, and no evidence of recurrence was noted.

INTRODUÇÃO: Rinoscleroma é uma doença infecciosa crônica do tipo granulomatosa causada pela bactéria Klebsiella rhinoscleromatis. Acomete a mucosa do trato respiratório, mais frequentemente o nariz. É considerada endêmica em determinadas regiões com África e América Central, porém é rara no Brasil. O acometimento nasal ocorre em 3 fases: catarral, granulomatosa e cicatricial. Em todo o seu curso a doença apresenta sintomatologia inespecífica, daí a dificuldade em ser diagnosticada. Seu diagnóstico é estabelecido através de cultura ou pelo encontro de células de Mikulicz ou corpúsculo de Russel no estudo anatomopatológico. O tratamento consiste em antibioticoterapia por longo período, associada ou não a cirurgia. OBJETIVO: Este relato tem por objetivo ilustrar um caso de rinoscleroma em uma paciente jovem com queixa de obstrução nasal bilateral de longa data e cefaleia. O intuito é alertar os otorrinolaringologistas para o diagnóstico desta doença rara, que se apresenta com sintomas inespecíficos e semelhantes a inúmeras patologias que acometem a região nasal. INTRODUCTION: Rhinoscleroma is a chronic granulomatous infectious disease, caused by the bacterium Klebsiella rhinoscleromatis. Affects the respiratory tract mucosa, more frequent in the nose. Is considered endemic in certain regions like Africa and Central America, but is rare in Brazil. The nasal involvement occurs in 3 phases: catarrhal, granulomatous and sclerotic stage. In all its course the disease presents nonspecific symptoms, and because of that, the difficulty of being diagnosed. Its diagnosis is established by culture or by the meeting of Mikulicz cell or Russel corpuscles in the anatomopathological study. The treatment consists in a long-term antibiotic, associated or not to a surgery. OBJECTIVE: This report aims ilustrate a case of rhinoscleroma in a female young patient complaining of bilateral nasal obstruction, long standing and headache. The intent is alert the otorhinolaringologists in diagnosing this rare disease, which presents itself with nonspecific symptoms as like numerous pathologies that affect the nasal region.

Rhinoscleroma is a chronic, infectious and granulomatous disease of the respiratory tract. There is often a delay in diagnosis due to unfamiliarity with the disease and also because culture is not always positive. We report a case in a 26-year-old woman with granular mass obstructing bilateral nasal cavities and causing breathing difficulty. Histopathological examination showed characteristic Mikulicz histiocytes containing numerous Gram-negative intracellular rod-shaped bacilli consistent with the diagnosis of rhinoscleroma. The patient was treated with gemifloxacin and tetracycline and remains asymptomatic over a year follow-up period. It is important to consider rhinoscleroma in cases of chronic nasal obstruction. As culture is not always positive, histopathological examination may be crucial to the diagnosis. Keywords: rhinoscleroma, nasal obstruction, histopathology

INTRODUÇÃO: Rinoscleroma é uma doença infecciosa crônica do tipo granulomatosa causada pela bactéria Klebsiella rhinoscleromatis. Acomete a mucosa do trato respiratório, mais frequentemente o nariz. É considerada endêmica em determinadas regiões com África e América Central, porém é rara no Brasil. O acometimento nasal ocorre em 3 fases: catarral, granulomatosa e cicatricial. Em todo o seu curso a doença apresenta sintomatologia inespecífica, daí a dificuldade em ser diagnosticada. Seu diagnóstico é estabelecido através de cultura ou pelo encontro de células de Mikulicz ou corpúsculo de Russel no estudo anatomopatológico. O tratamento consiste em antibioticoterapia por longo período, associada ou não a cirurgia. OBJETIVO: Este relato tem por objetivo ilustrar um caso de rinoscleroma em uma paciente jovem com queixa de obstrução nasal bilateral de longa data e cefaleia. O intuito é alertar os otorrinolaringologistas para o diagnóstico desta doença rara, que se apresenta com sintomas inespecíficos e semelhantes a inúmeras patologias que acometem a região nasal.

O tratamento da surdez súbita é uma das questões mais controversas da Otologia. No entanto, os corticoides sistêmicos têm sido a opção mais escolhida por referidos autores como padrão ouro de tratamento. O uso de corticoide intratimpânico como terapia de segunda linha para tratamento de casos refratários de surdez súbita tem sido relatado e os resultados promissores têm feito alguns autores promoverem o seu uso como terapia de primeira linha, indicando-a para todos os casos de surdez súbita. OBJETIVOS: Descrever essa nova modalidade de tratamento e avaliar a sua segurança e eficácia em quatorze pacientes tratados após falha da corticoterapia oral. MATERIAIS E MÉTODOS: Trata-se de estudo analítico prospectivo em que quatorze pacientes portadores de surdez súbita neurossensorial foram tratados com metilprednisolona intratimpânica após falha da corticoterapia oral. Limiares tonais e o índice de reconhecimento de fala pré-tratamento e pós-tratamento foram analisados. RESULTADOS: Dez dos quatorze pacientes tratados com metilprednisolona intratimpânica apresentaram recuperação da audição superior a 20 dB nos limiares tonais ou 20% no IRF. CONCLUSÃO: Três injeções intratimpânicas de metilprednisolona aumentaram os limiares tonais e índices de reconhecimento da fala em um grupo de pacientes portadores de surdez súbita neurossensorial que não obtiveram benefício após corticoterapia oral. Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. AIM: To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone. METHODS: In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed. RESULTS: Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20% in SRT. CONCLUSION: Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.

Rhinoscleroma is a chronic, infectious and granulomatous disease of the respiratory tract. There is often a delay in diagnosis due to unfamiliarity with the disease and also because culture is not always positive. We report a case in a 26-year-old woman with granular mass obstructing bilateral nasal cavities and causing breathing difficulty. Histopathological examination showed characteristic Mikulicz histiocytes containing numerous Gram-negative intracellular rod-shaped bacilli consistent with the diagnosis of rhinoscleroma. The patient was treated with gemifloxacin and tetracycline and remains asymptomatic over a year follow-up period. It is important to consider rhinoscleroma in cases of chronic nasal obstruction. As culture is not always positive, histopathological examination may be crucial to the diagnosis.

Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids.To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone.In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed.Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery20 dB in PTA or 20% in SRT.Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.

A 12-year-old female patient started with sudden abdominal pain, polyuria, polydipsia, anorexia and a drop in cons-cience level. She was diagnosed with untreated type I diabetes mellitus (diabetic acidosis), with blood sugar of 508 mg/dl upon hospital admission. After one week in the hospital, she started having eyelid ptosis, facial pain, converging strabismus, left side epistaxis and a progressive wor-sening of her general health.Skull and paranasal sinuses CT scan and MRI showed a soft tissue mass in the left nasal cavity, invading the ethmoidal, maxillary and cavernous sinuses and the ipsilateral orbit (Figure 1).An endoscopic-guided tumor biop-sy showed mucormycosis. The patient was started in high doses of endovenous am-phothericin B liposome for 45 days. There was a mild improvement only. Anterior rhinoscopy showed a large brown-greenish mass occupying the entire left nasal cavity.We decided to do a nasosinusal endoscopic exploration. During the proce-dure we noticed a large mass coming from the maxillary sinus and the left nasal cavity. We did an exhaustive surgical debridement and cleaning in the maxillary, ethmoidal and sphenoidal sinuses with hypertonic saline solution, and we also flushed the region with an amphothericin B solution. Histology revealed a zygomycosis by Mu-cor genus fungi.The patient had a favorable outco-me and returned in one week for a review. Upon anterior rhinoscopy, we noticed a fungal mass. A new CT scan suggested tumor recurrence. The patient was then submitted to 29 daily sessions of oxygen therapy in a hyperbaric chamber and the amphothericin B was exchanged for intra-venous itraconazole because of the long term use of the former, and she was also submitted to a rigorous diabetic control.There was a mild improvement and stability on her condition, leading us to choose to do a second look endoscopic exploration. The left nasal cavity was broad and clear, without any evidence of infec-tion. The maxillary sinus ostium was open and there were no signs of mucormycosis.The patient was discharged from the hospital in a stable condition and using oral itraconazole. The endoscopic view confirmed disease clearance. She is currently asymptomatic. Her capillary glucose is strictly controlled. She has nerve palsy of the III and IV cranial nerves on the left, however with good visual acuity and no diplopia.