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Infection with Leishmania amazonensis and L. mexicana may lead to diffuse cutaneous leishmaniasis. The cure is exceptional, especially for the strange case of this lady. Case report: The patient acquired the disease in childhood and remained with lesions for over 30 years, albeit several treatments. She worsened after a pregnancy, developing disseminated lesions. Miltefosine with amphotericin B and pentamidine resulted in remission. Lesions reappeared after one year, accompanied by intra-nasal infiltration of the disease. The nasal spraying of a single ampoule of pentavalent antimoniate resulted in the sustained disappearance of the nasal symptoms and all the cutaneous lesions. After over eight years, she remains disease-free, albeit under renal replacement therapy. The high nasal mucosal antimonial concentration may explain the long-lasting cure via new MHC class I epitope-specific CD8+ cell clones against L. amazonensis present in the nasal mucosa.

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The objective was to evaluate the morphometric, productive and chemical aspects of purple elephant grass as a function of nitrogen fertilization. The treatments consisted of applying 0, 20, 40, 60, and 80 kg ha-1 of N, using a randomized block design, with five treatments and four replications. The following were evaluated: plant height, number, length and leaf mass, stem diameter and mass, leaf/stem ratio, production of green and dry mass, support capacity for dairy cows, crude protein, neutral detergent fiber and mineral matter. The data were submitted to analysis of variance and Tukey's test at 5% probability. The increase in N doses did not affect (p < 0.05) the morphometry of the purple elephant grass, however it positively stimulated the productivity, the animal support capacity and the bromatological components of the harvested material. The lack of response to nitrogen fertilization may be related to the edaphocilimatic conditions during the experiment and efficiency in the use of N of the variety used. The results demonstrate the high demand of the cultivar for N, actively interfering in the forage yield.

The objective was to evaluate the morphometric, productive and chemical aspects of purple elephant grass as a function of nitrogen fertilization. The treatments consisted of applying 0, 20, 40, 60, and 80 kg ha-1 of N, using a randomized block design, with five treatments and four replications. The following were evaluated: plant height, number, length and leaf mass, stem diameter and mass, leaf/stem ratio, production of green and dry mass, support capacity for dairy cows, crude protein, neutral detergent fiber and mineral matter. The data were submitted to analysis of variance and Tukey's test at 5% probability. The increase in N doses did not affect (p < 0.05) the morphometry of the purple elephant grass, however it positively stimulated the productivity, the animal support capacity and the bromatological components of the harvested material. The lack of response to nitrogen fertilization may be related to the edaphocilimatic conditions during the experiment and efficiency in the use of N of the variety used. The results demonstrate the high demand of the cultivar for N, actively interfering in the forage yield.

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The objective was to evaluate the morphometric, productive and chemical aspects of purple elephant grass as a function of nitrogen fertilization. The treatments consisted of applying 0, 20, 40, 60, and 80 kg ha-1 of N, using a randomized block design, with five treatments and four replications. The following were evaluated: plant height, number, length and leaf mass, stem diameter and mass, leaf/stem ratio, production of green and dry mass, support capacity for dairy cows, crude protein, neutral detergent fiber and mineral matter. The data were submitted to analysis of variance and Tukey's test at 5% probability. The increase in N doses did not affect (p < 0.05) the morphometry of the purple elephant grass, however it positively stimulated the productivity, the animal support capacity and the bromatological components of the harvested material. The lack of response to nitrogen fertilization may be related to the edaphocilimatic conditions during the experiment and efficiency in the use of N of the variety used. The results demonstrate the high demand of the cultivar for N, actively interfering in the forage yield.(AU)

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The objective was to evaluate the morphometric, productive and chemical aspects of purple elephant grass as a function of nitrogen fertilization. The treatments consisted of applying 0, 20, 40, 60, and 80 kg ha-1 of N, using a randomized block design, with five treatments and four replications. The following were evaluated: plant height, number, length and leaf mass, stem diameter and mass, leaf/stem ratio, production of green and dry mass, support capacity for dairy cows, crude protein, neutral detergent fiber and mineral matter. The data were submitted to analysis of variance and Tukey's test at 5% probability. The increase in N doses did not affect (p < 0.05) the morphometry of the purple elephant grass, however it positively stimulated the productivity, the animal support capacity and the bromatological components of the harvested material. The lack of response to nitrogen fertilization may be related to the edaphocilimatic conditions during the experiment and efficiency in the use of N of the variety used. The results demonstrate the high demand of the cultivar for N, actively interfering in the forage yield.

The objective was to evaluate the morphometric, productive and chemical aspects of purple elephant grass as a function of nitrogen fertilization. The treatments consisted of applying 0, 20, 40, 60, and 80 kg ha-1 of N, using a randomized block design, with five treatments and four replications. The following were evaluated: plant height, number, length and leaf mass, stem diameter and mass, leaf/stem ratio, production of green and dry mass, support capacity for dairy cows, crude protein, neutral detergent fiber and mineral matter. The data were submitted to analysis of variance and Tukey's test at 5% probability. The increase in N doses did not affect (p < 0.05) the morphometry of the purple elephant grass, however it positively stimulated the productivity, the animal support capacity and the bromatological components of the harvested material. The lack of response to nitrogen fertilization may be related to the edaphocilimatic conditions during the experiment and efficiency in the use of N of the variety used. The results demonstrate the high demand of the cultivar for N, actively interfering in the forage yield.

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Pennisetum purp ureum Schum

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This study aimed to analyze and compare the agronomic characteristics and development of the root system by means of image processing of different cultivars of tropical grasses of the genera Brachiaria and Panicum. The experiment carried out at the experimental station of the Research, Rural extension and land regularization company of Paraiba EMPAER in Alagoinha - PB, in a rainfed agriculture system. In June 2019 to 45 days after sowing, the grasses were cut for aerial part evaluation: biomass composition, forage yield, root system: volume and surface area of the cultivars Mombaça, Tamani, Zuri, Massai, Piatã and Ipyporã. There was a difference between cultivars for all variables analyzed, except for the leaf: stem ratio. The cv. Mombaça was the one that presented the best agronomic and root results, being the one that best adapted the edaphoclimatic conditions of the region, in contrast to Ipyporã was the least expressive for forage yield and water efficiency. These aerial characteristics and their relationship with root diagnosis are of great importance for choosing the cultivar that best suits certain environmental conditions at the time of cultivation.

Este estudo teve como objetivo analisar e comparar as características agronômicas e o desenvolvimento do sistema radicular por meio do processamento de imagens de diferentes cultivares de gramíneas tropicais dos gêneros Brachiaria e Panicum. O experimento foi realizado na estação experimental da empresa de Pesquisa, Extensão Rural e Regularização Fundiária da Paraíba - EM PAER em Alagoinha - PB, em um sistema de sequeiro. Em junho de 2019 a 45 dias após a semeadura, as gramíneas foram cortadas para avaliação das partes aéreas: composição da biomassa, produção de forragem, sistema radicular: volume e área superficial das cultivares Mombaça, Tamani, Zuri, Massai, Piatã e Ipyporã. Houve diferença entre as cultivares para todas as variáveis analisadas, exceto para a relação folha: caule. O cv. Mombaça foi a que apresentou os melhores resultados agronômicos e radiculares, sendo a que melhor adaptou as condições edafoclimáticas da região, ao contrário de Ipyporã, foi a menos expressiva para rendimento de forragem e eficiência da água. Essas características aéreas e sua relação com o...

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This study aimed to analyze and compare the agronomic characteristics and development of the root system by means of image processing of different cultivars of tropical grasses of the genera Brachiaria and Panicum. The experiment carried out at the experimental station of the Research, Rural extension and land regularization company of Paraiba EMPAER in Alagoinha - PB, in a rainfed agriculture system. In June 2019 to 45 days after sowing, the grasses were cut for aerial part evaluation: biomass composition, forage yield, root system: volume and surface area of the cultivars Mombaça, Tamani, Zuri, Massai, Piatã and Ipyporã. There was a difference between cultivars for all variables analyzed, except for the leaf: stem ratio. The cv. Mombaça was the one that presented the best agronomic and root results, being the one that best adapted the edaphoclimatic conditions of the region, in contrast to Ipyporã was the least expressive for forage yield and water efficiency. These aerial characteristics and their relationship with root diagnosis are of great importance for choosing the cultivar that best suits certain environmental conditions at the time of cultivation.(AU)

Este estudo teve como objetivo analisar e comparar as características agronômicas e o desenvolvimento do sistema radicular por meio do processamento de imagens de diferentes cultivares de gramíneas tropicais dos gêneros Brachiaria e Panicum. O experimento foi realizado na estação experimental da empresa de Pesquisa, Extensão Rural e Regularização Fundiária da Paraíba - EM PAER em Alagoinha - PB, em um sistema de sequeiro. Em junho de 2019 a 45 dias após a semeadura, as gramíneas foram cortadas para avaliação das partes aéreas: composição da biomassa, produção de forragem, sistema radicular: volume e área superficial das cultivares Mombaça, Tamani, Zuri, Massai, Piatã e Ipyporã. Houve diferença entre as cultivares para todas as variáveis analisadas, exceto para a relação folha: caule. O cv. Mombaça foi a que apresentou os melhores resultados agronômicos e radiculares, sendo a que melhor adaptou as condições edafoclimáticas da região, ao contrário de Ipyporã, foi a menos expressiva para rendimento de forragem e eficiência da água. Essas características aéreas e sua relação com o...(AU)

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Reversible posterior leukoencephalopathy syndrome (RPLS) is clinical radiologic condition associated with neurological symptoms and cerebral white matter edema. It has been associated with uncontrolled hypertension, eclampsia, immunosuppressants, and more recently the use of antiangiogenic drugs. Sunitinib is an inhibitor of the vascular endothelial growth factor receptor widely used in the treatment of metastatic renal cell carcinoma (RCC). We report a rare case of RPLS occurring on therapy with sunitinib in a patient with RCC. Our aim is to highlight the importance of considering RPLS as a diagnostic possibility and to hold sunitinib for RCC patients presenting with neurologic symptoms.

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Brain metastases occur in up to 10-30% of patients with cancer. Metastatic lesions are usually diagnosed as multiple mass lesions at the junction of the grey and white matter with associated perilesional vasogenic oedema. Cysticercosis is an endemic disease in underdeveloped countries of Africa, Central and South America and is the most common parasitic infection of the central nervous system. The classical radiological finding of neurocysticercosis is cystic lesions showing the scolex in the brain parenchyma. We report a case of metastatic adenocarcinoma of the lung presenting with cystic brain lesions mimicking neurocysticercosis.

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Insulinoma is a rare pancreatic neuroendocrine tumor. Overproduction of insulin and associated hypoglycemia are hallmark features of this disease. Diagnosis can be made through demonstration of hypoglycemia and elevated plasma levels of insulin or C-Peptide. Metastatic disease can be detected through computerized tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT. Somatostatin receptor scintigraphy can be used not only to document metastatic disease but also as a predictive marker of the benefit from therapy with radiolabeled somatostatin analog. Unresectable metastatic insulinomas may present as a major therapeutic challenge for the treating physician. When feasible, resection is the mainstay of treatment. Prevention of hypoglycemia is a crucial goal of therapy for unresectable/metastatic tumors. Diazoxide, hydrochlorothiazide, glucagon, and intravenous glucose infusions have been used for glycemic control yielding temporary and inconsistent results. Sandostatin and its long-acting depot forms have occasionally been used in the treatment of Octreoscan-positive insulinomas. Herein, we report a case of metastatic insulinoma with very difficult glycemic control successfully treated with the radiolabeled somatostatin analog lutetium ((177)LU).

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BACKGROUND: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients. METHODS: This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis. RESULTS: A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval [CI] 1.38-12.6), diabetes (RR 3.63, 95% CI 1.17-11.2), unplanned surgery (RR 3.62, 95% CI 1.18-11.0), age (RR 1.04, 95% CI 1 0.01-1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14-2.02), a high central venous pressure (RR 1.12, 95% CI 1.04-1.22), a fast heart rate (RR 3.63, 95% CI 1.17-11.2) and pH (RR 0.04, 95% CI 0.0005-0.38) on the day of admission were independent predictors of death due to MOF. CONCLUSIONS: MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.

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OBJETIVO: determinar a presença, ou não, de instabilidade lombar após a realização de facetectomia total unilateral para a descompressão radicular. MÉTODOS: os autores realizaram uma análise retrospectiva por avaliação clínica e radiográfica de 29 pacientes operadores, por discopatia, durante o período de janeiro de 1985 até janeiro de 1995. Os pacientes apresentavam queixa de dor ciática aguda, sem dor lombar prévia, e foram submetidos à facetectomia total unilateral para a descompressão radicular. Os casos operados por esta técnica necessitaram de manipulações excessivas com riscos de lesão da raiz nervosa. RESULTADOS: após um seguimento que variou de 9 a 17 anos, os resultados foram excelentes em 17 pacientes, bom em 9, regular em 3. CONCLUSÃO: nessa série de casos, a facetectomia total unilateral não foi fator determinante de instabilidade lombar.

OBJECTIVE: to determine the presence or absence of lumbar instability after the execution of unilateral total facetectomy for the root decompression. METHODS: the authors made a retrospective review by clinical and radiological evaluation of 29 discopathy operated patients, during the period from January 1985 to January 1995. These patients presented acute sciatica without previous lumbar pain, and they were submitted to unilateral total facetectomy for the radicular decompression. In this series, all cases needed an excessive manipulation and were under the risks of root lesion. RESULTS: after a follow-up that varied from 9 to 17 years old, the results were excellent for 17 patients, good for 9 and regular for 3. CONCLUSION: in these cases, unilateral total facetectomy was not a determinant factor of lumbar instability.

OBJETIVO: determinar la presencia o no de la inestabilidad lumbar después de la realización de facetectomía total unilateral para la descompresión radicular. MÉTODOS: los autores realizaron un análisis retrospectivo por evaluación clínica y radiográfica de 29 pacientes operados por discopatía, durante el periodo de Enero de 1985 hasta Enero de 1995. Los pacientes presentaban queja de dolor ciática aguda, sin dolor lumbar previa y fueron sometidos a la facetectomía total unilateral para la descompresión radicular. Los casos operados por esta técnica necesitaron de manipulaciones excesivas con riesgo de lesión de la raíz nerviosa. RESULTADOS: después de un seguimiento que varió de 9 a 17 años, los resultados fueron excelentes en 17 pacientes, bueno en 9 y regular en 3. CONCLUSIÓN: en esa serie de casos la facetectomía total unilateral no fue factor determinante de inestabilidad lumbar.

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A mamoplastia redutora promove várias alterações na forma e volume da glândula mamária. A mudança de posicionamento no tórax de maneira satisfatória para a maioria das pacientes, permitindo resultado estético almejado. A redução da mama apresentou resultados de cicatrizes que puderam ser correlacionados com algumas medidas pré determinadas como a base, a altura, a distância da clavícula-mamilo e distância fúcula sulco. Foram operadas 40 pacientes brancas com idade que variou de 14 a 51 anos.

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O objetivo desse trabalho foi analisar matematicamente, de forma padronizada, o cálculo do volume mamário no pré e pós operatório imediato de pacientes submetidos à técnica de redução e sua repercussão no estado nutricional das pacientes através de massa corpórea. Foram operadas 40 pacientes, brancas, com idade que variou de 14 a 51 anos, com peso de 43 a 79 kl e altura de 1m46 a 1m70. Realizaram-se mensurações da base e altura da mama e calculou-se o volume baseado em fórmula desenvolvida pelos autores. Os resultados demonstraram que houve redução, em média, de 40% do volume das mamas operadas e que a cirurgia interfiriu significantemente no índice de massa corpórea.

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Após breve revisäo da literatura sobre a necrose do semilunar (NSL), os autores fazem o relato de um caso de NSL em um paciente de dez anos de idade. O diagnóstico foi feito baseado na história clínica, exame físico e exame radiológico. O paciente foi tratado cirurgicamente com osteotomia para encurtamento do rádio, tendo apresentado rápido restabelecimento clínico e radiológico. Os autores concluem tratar-se de caso raro pela idade em que se desenvolveu a doença.

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