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In this technical report study, we describe technique for performing the osteotomy and screw passage in minimally invasive fourth-generation hallux valgus surgery with transverse and akin extra-articular metaphyseal osteotomy (META) using a 3D-printed patient-specific surgical instrumentation guide. In an effort to minimize the learning curve and address the variability associated with technical corrections and screw placement, we have initiated the creation of personalized patient-specific instrumentation guides using 3D printing. Our hypothesis is that this approach will enhance safety, precision, decrease surgical time, and reduce exposure to radiation. Level of Evidence: Level V, expert opinion.

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Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.

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Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein, and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this article is to report two cases of PVT in which it was not associated with cirrhosis. Both were treated with anticoagulation and clinical progress afterwards was good.

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Resumo A trombose de veia porta (TVP) é uma doença na qual ocorre trombose desde os ramos intra-hepáticos da veia porta, podendo se estender até a veia esplênica e/ou veia mesentérica superior, estando associada, na maioria das vezes, à cirrose hepática. A TVP não associada a cirrose é rara. O objetivo deste artigo foi relatar dois casos de TVP não associados à cirrose, que foram tratados com anticoagulação e tiveram evolução clínica satisfatória.

Abstract Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein, and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this article is to report two cases of PVT in which it was not associated with cirrhosis. Both were treated with anticoagulation and clinical progress afterwards was good.

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Abdominal aortic aneurysms (AAA) are the most common type, even when compared to those involving other segments of the aorta. The prevalence and natural history of arterial aneurysms in abdominal organ transplant recipients remain uncertain. We report a case of abdominal aortic aneurysm in a kidney transplant patient with contrast allergy. Conventional abdominal aortic aneurysm repair was performed, constructing a bi-iliac aortic bypass. A temporary bypass was constructed from the right axillary artery to the right common iliac artery to maintain the renal graft. The patient was transferred to the intensive care unit, where he remained hemodynamically stable, and he was discharged on the 2nd postoperative day. Conventional open surgery with temporary extra-anatomic bypass is an alternative option for treatment of AAA in patients with transplanted kidneys.

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Assessing the seasonal patterns of the Amazon rainforests has been difficult because of the paucity of ground observations and persistent cloud cover over these forests obscuring optical remote sensing observations. Here, we use data from a new generation of geostationary satellites that carry the Advanced Baseline Imager (ABI) to study the Amazon canopy. ABI is similar to the widely used polar orbiting sensor, the Moderate Resolution Imaging Spectroradiometer (MODIS), but provides observations every 10-15 min. Our analysis of NDVI data collected over the Amazon during 2018-19 shows that ABI provides 21-35 times more cloud-free observations in a month than MODIS. The analyses show statistically significant changes in seasonality over 85% of Amazon forest pixels, an area about three times greater than previously reported using MODIS data. Though additional work is needed in converting the observed changes in seasonality into meaningful changes in canopy dynamics, our results highlight the potential of the new generation geostationary satellites to help us better understand tropical ecosystems, which has been a challenge with only polar orbiting satellites.

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Resumo Os aneurismas de aorta abdominal (AAA) são os mais frequentes, mesmo quando comparados a outros segmentos da aorta. A prevalência e a história natural de aneurismas arteriais em receptores de transplante de órgão abdominal permanecem incertas. Relatamos a abordagem de um caso de aneurisma de aorta abdominal em um paciente transplantado renal e com alergia ao contraste. Foi realizado o tratamento convencional do aneurisma de aorta abdominal com um by-pass aorto bi-ilíaco. Para manutenção do enxerto renal, foi confeccionado um by-pass temporário da artéria axilar direita até a artéria ilíaca comum direita. O paciente foi encaminhado para a unidade de terapia intensiva, onde permaneceu estável hemodinamicamente e recebeu alta no 2º pós-operatório. A cirurgia convencional aberta com derivação extra-anatômica temporária é uma alternativa para o tratamento do AAA em pacientes com transplante renal.

Abstract Abdominal aortic aneurysms (AAA) are the most common type, even when compared to those involving other segments of the aorta. The prevalence and natural history of arterial aneurysms in abdominal organ transplant recipients remain uncertain. We report a case of abdominal aortic aneurysm in a kidney transplant patient with contrast allergy. Conventional abdominal aortic aneurysm repair was performed, constructing a bi-iliac aortic bypass. A temporary bypass was constructed from the right axillary artery to the right common iliac artery to maintain the renal graft. The patient was transferred to the intensive care unit, where he remained hemodynamically stable, and he was discharged on the 2nd postoperative day. Conventional open surgery with temporary extra-anatomic bypass is an alternative option for treatment of AAA in patients with transplanted kidneys.

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Semiology is the backbone of any correct categorization of seizures, as epileptic or not, focal or bilateral, and is fundamental to elucidating how they are anatomically generated in the brain. An anatomical hypothesis derived from seizure history is the precondition for optimally designed ancillary studies. Without understanding seizure semiology, no rational therapy is possible. This article describes the semiological approach using patient history based on full use of patients' self-reports as well as descriptions by witnesses. Auras represent the subjective aspects of seizures and provide important semiological clues as observable signs, sometimes including rather precise direct anatomical information. Methods of extracting, facilitating and analysing self-reports including linguistic conversation analysis are presented in detail. It is highlighted that prodromes, seizure triggers and reflex epileptic mechanisms can provide crucial information for diagnostics and therapy. Special issues considering seizure semiology in children are discussed in a separate section. Other sections are dedicated to the two most important issues of differential diagnosis: how to distinguish (1) focal from "generalized" epilepsies, particularly when focal seizure phenomena appear in a bilateral epilepsy; and (2) epileptic from a series of non-epileptic events.

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BACKGROUND: Aortic injuries caused by blunt chest traumas have high pre-hospital and emergency mortality. The endovascular approach is one option for treatment of these injuries, but many outcomes related to this approach remain unknown. OBJECTIVES: The aim of this study is to describe a specialist trauma center's experience with endovascular treatment of cases like these. METHODS: This is a descriptive study based on review of the electronic medical records of patients who had suffered from blunt thoracic aorta trauma and were seen at a hospital specializing in trauma cases in the city of Curitiba (Paraná, Brazil). RESULTS: Sixteen patients were included in the study. All patients were traffic accident victims and 75% of the accidents were the result of vehicle collisions. Aortic lesions ranged from grade I to IV and the majority had grade II lesions (50%). All patients underwent endovascular treatment with endografts, an average of 71 hours after the trauma. Two patients died, both from causes unrelated to their aortic injuries. During follow-up, only two patients presented complications (endoleak and progression of the dissection). CONCLUSIONS: The endovascular method is a viable alternative for treatment of blunt trauma thoracic aortic injuries. Randomized and controlled studies are needed to provide evidence to support indication of this method to treat this type of injury.

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In the current scenario, traumas with violent causes are responsible for large numbers of cases. Among these, thoracic aorta injury caused by penetrating trauma is a cause of elevated morbidity and mortality, demanding adequate diagnosis, and can now often be repaired using endovascular procedures. This treatment method has proven to be safer, with a lower rate of complications than open surgical procedures. After endovascular repair, it is necessary to conduct continuous monitoring of the patient's health and correct any complications related to the procedure that may emerge. The objective of this article is to describe a case of penetrating trauma of the thoracic aorta that was treated endovascularly, since the literature predominantly covers blunt trauma injuries.

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Resumo O cenário atual do trauma por causas violentas tem apresentado um elevado número de casos. Entre eles, a lesão de aorta torácica por trauma penetrante é uma condição de elevada morbimortalidade que exige diagnóstico adequado e que, nos últimos anos, tem sido corrigida com procedimentos endovasculares. Essa modalidade de tratamento se mostra mais segura, com menor número de complicações em relação ao procedimento cirúrgico aberto. Após a realização da abordagem endovascular, há necessidade de acompanhamento contínuo, que visa monitorar as condições de saúde do paciente e corrigir possíveis complicações relacionadas ao procedimento. O objetivo deste artigo é relatar um caso de traumatismo penetrante de aorta torácica, tratado por via endovascular, visto que a literatura aborda predominantemente as lesões por trauma contuso.

Abstract In the current scenario, traumas with violent causes are responsible for large numbers of cases. Among these, thoracic aorta injury caused by penetrating trauma is a cause of elevated morbidity and mortality, demanding adequate diagnosis, and can now often be repaired using endovascular procedures. This treatment method has proven to be safer, with a lower rate of complications than open surgical procedures. After endovascular repair, it is necessary to conduct continuous monitoring of the patient's health and correct any complications related to the procedure that may emerge. The objective of this article is to describe a case of penetrating trauma of the thoracic aorta that was treated endovascularly, since the literature predominantly covers blunt trauma injuries.

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Resumo Contexto As lesões de aorta nos traumatismos torácicos fechados possuem alta mortalidade pré-hospitalar e no serviço de emergência. O tratamento endovascular é um método de escolha para o tratamento dessas lesões; entretanto, muitos resultados em relação a essa abordagem permanecem desconhecidos. Objetivos O objetivo deste trabalho é descrever a experiência no tratamento endovascular de lesões traumáticas de aorta torácica em um centro de referência em trauma. Métodos Este trabalho trata-se de estudo descritivo realizado através da revisão de prontuários eletrônicos de pacientes vítimas de trauma contuso de aorta torácica, atendidos em um hospital de referência em trauma na cidade de Curitiba (Paraná, Brasil). Resultados Dezesseis pacientes foram incluídos no estudo. Todos os pacientes foram vítimas de acidente de trânsito, sendo que 75% dos acidentes ocorreram por colisão entre veículos. As lesões de aorta variaram de Grau I a IV, e a maioria dos pacientes apresentou lesão de grau II (50%). Todos os pacientes foram submetidos a terapia endovascular com implante de endoprótese sendo realizado em média 71 horas após o trauma. Dois pacientes evoluíram a óbito, porém de causas não relacionadas à lesão de aorta. Durante o seguimento, apenas dois pacientes apresentaram complicações (endoleak e progressão da dissecção). Conclusões O método endovascular é uma alternativa viável no tratamento de lesões de aorta torácica por trauma contuso. São necessários estudos randomizados e controlados a fim de reforçar a indicação desse método como terapia para esse tipo de lesão.

Abstract Background Aortic injuries caused by blunt chest traumas have high pre-hospital and emergency mortality. The endovascular approach is one option for treatment of these injuries, but many outcomes related to this approach remain unknown. Objectives The aim of this study is to describe a specialist trauma center's experience with endovascular treatment of cases like these. Methods This is a descriptive study based on review of the electronic medical records of patients who had suffered from blunt thoracic aorta trauma and were seen at a hospital specializing in trauma cases in the city of Curitiba (Paraná, Brazil). Results Sixteen patients were included in the study. All patients were traffic accident victims and 75% of the accidents were the result of vehicle collisions. Aortic lesions ranged from grade I to IV and the majority had grade II lesions (50%). All patients underwent endovascular treatment with endografts, an average of 71 hours after the trauma. Two patients died, both from causes unrelated to their aortic injuries. During follow-up, only two patients presented complications (endoleak and progression of the dissection). Conclusions The endovascular method is a viable alternative for treatment of blunt trauma thoracic aortic injuries. Randomized and controlled studies are needed to provide evidence to support indication of this method to treat this type of injury.

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Hemangiomas são tumores vasculares benignos raros na mama. São de origem extraparenquimal e desenvolvem-se no tecido celular subcutâneo. O diagnóstico por exames de imagem pode ser difícil já que não apresentam características específicas, podendo ser confundidos com tumores malignos. Relatamos nesse artigo o caso de uma paciente portadora de hemangioma mamário em que a mamografia de rastreamento inicialmente demonstrou resultado inconclusivo, havendo necessidade de complementação diagnóstica com exame clínico e ultrassonografia para o laudo final de achados benignos (BI-RADS 2)

Hemangiomas are rare benign vascular tumors in the breast. They have extra parenchymal developing in the subcutaneous cellular tissue. Diagnosis by imaging exams can be difficult since this type of benign tumor does not have specific characteristics and can be confused with malignant tumors. We report in this article the case of a patient with breast hemangioma on screening mammography who initially had inconclusive result requiring clinical examination and ultrasound for the final report of benign findings (BI-RADS 2)

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La enfermedad de Still se caracteriza por ser una enfermedad inflamatoria, sis-témica, rara, sin etiología y patogénesis establecidas. Su tríada clásica de manifesta-ción es fiebre alta de origen desconocido, artralgia persistente y erupción cutánea de color salmón, además de manifestaciones sistémicas. El diagnóstico es clínico y requiere la exclusión de enfermedades infecciosas, neoplásicas y otras enfermeda-des autoinmunes, pues no posee marcadores biológicos específicos. Los exámenes de laboratorio son inespecíficos y muestran una actividad inmunológica exacerbada. El tratamiento incluye medicamentos antiinflamatorios no esteroideos, corticosteroi-des, inmunosupresores, gammaglobulina intravenosa y agentes biológicos. Describi-mos el caso de un paciente de 25 años con fiebre vespertina diaria sin foco conocido y artralgia migratoria, sin erupciones cutáneas.

Still's disease is characterized by being a rare systemic inflammatory disease with no established etiology and pathogenesis. Its classic manifestation triad is high fever of unknown origin, persistent arthralgia and salmon-colored rash, in addition to systemic manifestations. The diagnosis is clinical and requires the exclusion of infec-tious, neoplastic and other autoimmune diseases, as it does not have specific biologi-cal markers. Laboratory tests are non-specific and show exaggerated immune activity. Treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, immu-nosuppressants, intravenous gammaglobulin and biological agents. We describe the case of a 25-year-old patient with daily afternoon fever with no known focus and migratory arthralgia without rash.

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O complexo tratamento de dissecção da aorta ainda apresenta controvérsias devido à gravidade do caso e à necessidade de individualização da terapêutica. A gravidade relaciona-se ao difícil diagnóstico pelas queixas inespecíficas e pelas graves complicações inerentes à evolução da doença (ruptura aórtica, síndrome de má perfusão, dissecção retrógrada, dor ou hipertensão refratária). Este relato apresenta um homem de 61 anos, tabagista e hipertenso mal controlado, que evoluiu para dissecção aórtica de tipo B de Stanford. Foi abordado através de técnica endovascular com uso de endoprótese com stent para tratamento do caso após falha do tratamento medicamentoso. O tratamento endovascular mostrou-se uma ferramenta eficaz para o tratamento definitivo, com boa taxa de sobrevida ao final do primeiro ano após o procedimento

Complex treatment of aortic dissection is still a controversial subject because of the severity of these cases and the need to treat on a case-by-case basis. Severity is related to the difficulty of diagnosis caused by nonspecific complaints and by the serious complications inherent to disease progression (aortic rupture, hypoperfusion syndrome, retrograde dissection, refractory hypertension or pain). This article reports the case of a 61-year-old male smoker with poorly controlled hypertension who suffered a Stanford type B aortic dissection. After drug-based treatment failed, the patient was treated using endovascular techniques to place an endoprosthesis with stenting. Endovascular treatment is proving to be an effective tool for definitive treatment, with a good survival rate at the end of the first year after the procedure

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As doenças sistêmicas crônicas têm maior prevalência nos pacientes idosos, elevando os riscos de morbimortalidade. As alterações do sistema gastrointestinal podem trazer complicações para qualidade de vida destes. O objetivo deste estudo é determinar a prevalência de sintomas gastrointestinais numa amostra de pacientes idosos e a associação com comorbidades e uso de medicações. Metodologia: Foram selecionados 100 pacientes idosos (idade ≥ 60 anos) do Ambulatório do Hospital Evangélico de Curitiba, submetidos a entrevista estruturada e preenchimento de questionário padronizado de sintomas gastrointestinais. Foi analisada a associação com comorbidades, uso de medicamentos e busca de ajuda médica. Os dados coletados foram analisados através do percentual. Resultados: O estudo mostrou uma prevalência de sintomas gastrointestinais em idosos de 78%. A disfagia (37%), plenitude pós prandial (29%) e a constipação intestinal (25%) foram os sintomas esofágico, dispéptico e intestinal mais prevalentes, respectivamente. Dos pacientes sintomáticos, 56,41% procuraram ajuda médica e 53,8% utilizaram medicações sem orientações. A manifestação gastrointestinal mais comum nas mulheres foi plenitude pós prandial e pirose nos homens. Dos pacientes entrevistados, 19 apresentavam diabetes melitus e o sintoma mais prevalente foi a disfagia. As doenças cardiovasculares foram encontrados em 70 pacientes e a manifestação prevalente foi a pirose. As doenças osteomusculares foram encontradas em 42 dos pacientes e o sintoma mais frequente foi a pirose. Conclusão: O presente estudo mostrou que a prevalência de sintomas gastrointestinais é alta na população idosa, assim como apontam outros estudos. As doenças associadas e uso de medicações podem interferir na prevalência de sintomas, mas não foi encontrada em proporção significativa no estudo

The chronic systemic diseases are more prevalent in older patients, increasing the risk of mortality. Changes in gastrointestinal system can bring complications to the quality of life of these. Objectives: To determine the prevalence of gastrointestinal symptoms in a sample of elderly patients and association with comorbidities and use of medications. Methodology: A total of 100 elderly (age ≥ 60 years) patients at the Evangelic Hospital in Curitiba were interviewed and answered a standardized questionnaire with gastrointestinal symptoms. The association with comorbidities such as diabetes mellitus, cardiovascular and musculoskeletal diseases, use of drugs and seeking medical help were researched. The collected data were analyzed using percentage. Results: The study showed a prevalence of gastrointestinal symptoms in the elderly by 78%. Dysphagia (37%), postprandial fullness (29%) and constipation (25%) were esophageal, dyspeptic and bowel symptoms more prevalent, respectively. Symptomatic patients, 56.41% had sought medical help and 53.8% used medications. The most common gastrointestinal manifestation in women has been postprandial fullness and heartburn in men. Of the patients interviewed, 19 had diabetes mellitus and the most prevalent symptom was dysphagia. Cardiovascular diseases were found in 70 patients and prevalent manifestation was heartburn. Musculoskeletal diseases were found in 42 patients and the most frequent symptom was heartburn. Conclusion: This study showed that the prevalence of gastrointestinal symptoms in the elderly population is high, as reported in other studies. Associated diseases and medications can interfere with the prevalence of symptoms, but was not found in significant proportion in the study

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Resumen El objetivo del artículo es presentar el caso de un paciente que consultó al servicio de imaginología por dolor en la región costal, y quien posteriormente fue diagnosticado como histiocitosis de células de Langerhans. Se pretende proveer al lector una breve revisión de tema de imágenes diagnósticas de esta enfermedad para que el reconocimiento de la misma permanezca dentro de la lista de diagnósticos diferenciales.

Abstract The goal of this article is to provide readers with a case presentation of a patient who presented to the radiology department for pain located at the costal region, which later was diagnosed as Langerhans cell histiocytosis (LCH). We pretend with this article to provide a brief, complete and efficient literature review regarding the topic of imaging on this pathology. This was done with the objective of providing the reader with a brief and concise literature review so that this disease entity can remain within the list of differencials.