ABSTRACT Introduction: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. Methods: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords “congenitally corrected transposition of the great arteries” and “adults”. Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. Results: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. Conclusion: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.

Abstract Introduction: Adrenocortical and renal cell carcinomas rarely invade the right atrium (RA). These neoplasms need surgical treatment, are very aggressive and have poor prognostic and surgical outcomes. Case series: We present a retrospective cohort of nine cases of RA invasion through the inferior vena cava (four adrenocortical carcinomas and five renal cell carcinomas). Over 13 years (2002-2014), nine patients were operated in collaboration with the team of urologists. Surgery was possible in all patients with different degrees of technical difficulty. All patients were operated considering the imaging examinations with the aid of CPB. In all reported cases (renal or suprarenal), the decision to use CPB with deep hypothermic circulatory arrest (DHCA) on surgical strategy was decided by the team of urological and cardiac surgeons. Conclusion: Data retrospectively collected from patients of public hospitals reaffirm: 1) Low incidence with small published series; 2) The selected cases did not represent the whole historical casuistry of the hospital, since they were selected after the adoption of electronic documentation; 3) Demographic data and references reported in the literature were presented as tables to avoid wordiness; 4) The series highlights the propensity to invade the venous system; 5) Possible surgical treatment with the aid of CPB in collaboration with the urology team; 6) CPB with DHCA is a safe and reliable option; 7) Poor prognosis with disappointing late results, even considering the adverse effects of CPB on cancer prognosis are expected but not confirmed.

RESUMO A reprodução de peixes em rios com planície de inundação está associada ao regime de vazão e sua interação com os hábitats laterais. Entretanto, em rios confinados, sem planícies de inundação, pode-se esperar que a relação entre reprodução e vazão seja comparativamente distinta. Neste estudo, descrevemos as características reprodutivas da história de vida de Hemiancistrus fuliginosus e Hypostomus isbrueckeri em um rio confinado, discutimos as diferenças em relação à reprodução de loricarídeos em planícies de inundação e também as implicações para o efeito de barragens e manejo da vazão de rios. O pico reprodutivo de ambas as espécies ocorreu durante o período de baixa vazão, logo após o período de máxima vazão, contrastando com o padrão observado na reprodução de espécies em planícies de inundação, que ocorre principalmente no período de incremento de vazão. As duas espécies apresentaram história de vida com estratégia de equilíbrio. Pelo fato de ambas espécies desovarem durante a baixa vazão do rio, cuja ocorrência no verão é historicamente previsível, sugerimos que seus padrões de desova podem ser severamente alterados, dependendo de como o regime de vazão for afetado pela operação da barragem. Esses resultados têm implicações para avaliação e manejo de impactos ambientais de barragens em rios confinados, sendo que o manejo ecológico de vazão e a conservação de rios livres de barragens como alternativas de mitigação e conservação, respectivamente.

ABSTRACT Fish reproduction in floodplain rivers is often linked to flow regime and with the inundation of floodplain habitats. However, in confined rivers, where floodplains are absent, the relation between reproduction and flow can in comparison be expected to be distinct. In this study, we describe the reproductive life-history of Hemiancistrus fuliginosus and Hypostomus isbrueckeri in a confined river and discuss its differences relative to floodplain loricariids and also the implications for effects of dam construction and flow regulation. We found the reproductive peak of both species occurred during lowering waters, just after maximum river flow, in contrast to floodplain species that tend to spawn during rising waters. The studied species presented attributes of equilibrium life-history strategy, which are related to predictable river flow variation. Because both species spawned during low river flow, which is historically predictable in summer, we suggest that their reproduction may be severely disrupted, depending on how flow regime is affected by dam operation. These results have implications for assessing and mitigating the impacts of river damming on fish populations in confined rivers, and we point to ecologically driven flow management and conservation of free-flowing rivers as mitigation and conservation alternatives.

Abstract Objective: In cardiac surgery, the lung, renal and neurological events are the most frequent complications. Less common, acute liver failure is a serious complication that adds high morbidity, mortality, and costs. Therefore, this communication aimed to retrospectively evaluate five patients who presented, in 2014, severe acute liver failure in the immediate postoperative period. Methods: Retrospective data analysis of patients' medical records that showed severe liver failure has been computed in the medical records of five patients undergoing cardiac surgery at the Hospital da Faculdade de Medicina de Ribeirão Preto – USP in the immediate postoperative period from February 1, 2014 to December 12, 2014. The study selected five males patients, 60 to 67 years old, cardiopulmonary bypass mean time of 101.4 minutes (varying from 80 to 140 minutes), who presented acute perioperative liver failure. Results: The five patients showed an impressive increase of blood transaminase (serum alanine aminotransferase), suggesting acute hepatitis. The evolution of all patients was catastrophic, with severe hemodynamic effects and death. Many studies suggest that systemic hypotension is an important pathogenic factor for ischemic hepatitis. However, our data and previous studies raise the possibility that other yet unknown factors other than hypotension may be part of the pathophysiology of cardiopulmonary bypass after ischemic hepatitis (anticoagulation inadequate for the quality of heparin and protamine, etc.). Conclusion: Currently, there are no conclusive studies on the prevention of perioperative liver failure. More well-designed studies are needed on the introduction and evolution of liver dysfunction after cardiac surgery.

RESUMO Objetivo: o objetivo deste estudo foi comparar as doses equivalentes e efetivas absorvidas pelo mesmo receptor, quando exposto a diferentes exames radiográficos digitais (panorâmica, telerradiografia lateral e periapicais) e à tomografia computadorizada de feixe cônico (TCFC). Métodos: dosímetros termoluminescentes pré-calibrados foram colocados em 24 locais em um phantom antropomórfico (Alderson Rando Phantom, Laboratórios de Pesquisas de Alderson, New York, NY, EUA), o que representa um adulto de tamanho médio. Os seguintes equipamentos foram avaliados: Heliodent Plus (Sirona Dental Systems, Bernsheim, Alemanha), Orthophos XG 5 (Sirona Dental Systems, Bernsheim, Alemanha) e i-CAT (Imaging Sciences International, Hatfield, PA, EUA). As doses equivalentes e as doses efetivas foram calculadas tendo-se em conta as recomendações da Comissão Internacional de Proteção Radiológica (International Commission on Radiological Protection, ICRP), publicadas em 1990 e 2007. Resultados: embora a dose eficaz do set radiográfico tenha correspondido a 17,5% (ICRP 1990) e 47,2% (ICRP 2007) da dose da TCFC, as doses equivalentes na pele e superfícies ósseas e musculares desse set foram maiores, quando comparadas às da TCFC. Em algumas áreas, a radiação produzida pelo set de radiografias foi maior, devido à radiação do exame periapical completo. Conclusão: considerando-se o princípio da otimização da proteção radiológica, a tomografia computadorizada adquirida no tomógrafo i-CAT deve ser usada apenas em circunstâncias específicas e justificadas. Além disso, seguindo o princípio ALARA, radiografias periapicais unitárias de áreas pré-selecionadas são mais apropriadas do que o exame periapical completo.

ABSTRACT Objective: The aim of this study was to compare the equivalent and effective doses of different digital radiographic methods (panoramic, lateral cephalometric and periapical) with cone-beam computed tomography (CBCT). Methods: Precalibrated thermoluminescent dosimeters were placed at 24 locations in an anthropomorphic phantom (Alderson Rando Phantom, Alderson Research Laboratories, New York, NY, USA), representing a medium sized adult. The following devices were tested: Heliodent Plus (Sirona Dental Systems, Bernsheim, Germany), Orthophos XG 5 (Sirona Dental Systems, Bernsheim, Germany) and i-CAT (Imaging Sciences International, Hatfield, PA, USA). The equivalent doses and effective doses were calculated considering the recommendations of the International Commission of Radiological Protection (ICRP) issued in 1990 and 2007. Results: Although the effective dose of the radiographic set corresponded to 17.5% (ICRP 1990) and 47.2% (ICRP 2007) of the CBCT dose, the equivalent doses of skin, bone surface and muscle obtained by the radiographic set were higher when compared to CBCT. However, in some areas, the radiation produced by the orthodontic set was higher due to the complete periapical examination. Conclusion: Considering the optimization principle of radiation protection, i-CAT tomography should be used only in specific and justified circumstances. Additionally, following the ALARA principle, single periapical radiographies covering restricted areas are more suitable than the complete periapical examination.

OBJECTIVE: To describe trends, geographic distribution, and risk factors for cesarean deliveries in Brazil in 2000-2011, and to determine if efforts to curtail rates have had a measurable impact. METHODS: This was an observational study using nationwide information from the Department of Informatics of the Unified Health System (DATASUS). Individual level analyses were based on data regarding maternal education, age, parity, and skin color. Ecological analyses at the level of 431 health districts investigated the relationships with health facility density and poverty level. RESULTS: Cesarean rates increased markedly, from 37.9% in 2000 to 53.9% in 2011. Preliminary results from 2012 showed a rate of 55.8%, with the richest geographic areas showing the highest rates. Rates at the municipal level varied from 9%-96%. Cesareans were more common in women with higher education, white skin color, older age, and in primi- paras. In the ecological analyses, the number of health facilities per 1 000 population was strongly and positively correlated with cesarean rates, with an increase of 16.1 percentage points (95% Confidence Interval [95%CI] = 4.3-17.8) for each facility. An increase of 1 percentage point in the poverty rate was associated with a decline of 0.5 percentage point in cesarean rates (95%CI = 0.5-0.6). CONCLUSIONS: The strong associations with maternal education and health facility density suggest that the vast majority of cesareans are not medically indicated. A number of policies and programs have been launched to counteract this trend, but have had virtually no impact.

OBJETIVO: Describir las tendencias, la distribución geográfica, y los factores de riesgo de parto por cesárea en el Brasil durante el período del 2000 al 2011, y determinar si las iniciativas dirigidas a reducir las tasas de cesáreas han tenido una repercusión cuantificable. MÉTODOS: Se trata de un estudio de observación que utilizó información a escala nacional del Departamento de Informática del Sistema Unificado de Salud (DATASUS). Los análisis a nivel individual se basaron en datos sobre el nivel de formación materna, la edad, la paridad y el color de la piel. Se investigaron las relaciones con la densidad de establecimientos de salud y el nivel de pobreza mediante análisis ecológicos a nivel de 431 distritos de salud. RESULTADOS: Las tasas de cesáreas aumentaron notablemente, de 37,9% en el 2000 a 53,9% en el 2011. Los resultados preliminares del 2012 mostraron una tasa de 55,8%, con tasas más elevadas en las zonas geográficas más ricas. Las tasas a escala municipal variaron de 9 a 96%. Los partos por cesárea fueron más frecuentes en las mujeres blancas, en las que tenían un mayor nivel de formación, en las de mayor edad y en las primíparas. En los análisis ecológicos, el número de establecimientos de salud por 1 000 habitantes se correlacionó intensa y positivamente con la tasa de cesáreas, con un incremento de 16,1 puntos porcentuales (intervalo de confianza (IC) de 95% = 4,3-17,8) para cada establecimiento. Un aumento de un punto porcentual en la tasa de pobreza se asociaba con una disminución de medio punto porcentual en la tasa de cesáreas (IC de 95% = 0,5-0,6). CONCLUSIONES: Las intensas asociaciones con el nivel de formación materna y la densidad de establecimientos de salud indican que la mayor parte de las cesáreas no están indicadas médicamente. Se han puesto en marcha diversos programas y políticas dirigidos a contrarrestar esta tendencia, pero prácticamente no han tenido ninguna repercusión.

The experiment examined the effects of different drip irrigation systems in an O´Neal variety of blueberry (Vaccinium corymbosum L). It was contucted at Zarate (33º 41’ S and 59º 41’ W), Buenos Aires, Argentina. Plants of the experiment were planted in August of 2001, after one year in nursery. The first harvest was realized in October of 2003. The main scope of the experiment was to find the irrigation system which maximized yields. Treatments were: one drip irrigation line with drippers at 40 cm (T1) and two laterals with drippers at 20 cm per row (T2). The experiment was conducted in a completely randomized block design, each one with 5 plants and 5 replications. During the harvest of October and November of 2003, reported yields were 2436 kg ha-1 for the treatment T1 and 4335 kg ha-1 for the treatment T2. Treatments that partially irrigate beds are insufficient to obtain high yields.

El ensayo examinó los efectos de diferentes sistemas de riego por goteo en el rendimiento de la variedad O´Neal de arándano (Vaccinium corymbosum L). El estudio se realizó en Zarate (33º 41’ S y 59º 41’ W), provincia de Buenos Aires, Argentina. El cultivo se implantó en agosto de 2001, la primera cosecha se efectuó en octubre de 2003. El objetivo fue determinar cual era el sistema de riego por goteo que maximizaba el rendimiento, siendo los tratamientos, un lateral de tubería de goteo por fila de plantas con goteros a 40 cm (T1) y dos laterales de tubería de goteo con goteros a 20 cm por fila de plantas (T2). El porcentaje de suelo mojado por sistema se incrementa a medida que aumenta el número de emisores por metro lineal. El diseño experimental fue de bloques completamente aleatorizados, con bloques de cinco plantas y cinco repeticiones por tratamiento. La cosecha de 2003, reportó rendimientos de 2436 kg ha-1 para el tratamiento T1 y de 4335 kg ha-1 para tratamiento T2. El mojado parcial del suelo que realiza el tratamiento T1, de menor cantidad de goteros por metro lineal, no es suficiente para mojar un porcentaje de suelo compatible con altos rendimientos.

Seis espécies do gênero Astyanax, presentes no rio Maquiné, RS, foram estudadas quanto aos seus hábitos alimentares. Os exemplares foram amostrados bimensalmente de novembro de 1995 a setembro de 1996 nas zonas ritral e potamal do rio. Os itens alimentares foram identificados e quantificados de acordo com uma escala semi-quantitativa de abundância, utilizando-se para análise a frequência de ocorrência e um índice de importância alimentar para cada espécie e zona do rio. Análises multivariadas de agrupamento e ordenação foram utilizadas para comparar as dietas intra e interespecíficas. Todas as espécies foram consideradas onivoras, sendo que os itens mais importantes foram os insetos e restos de vegetais superiores. Sugere-se que as espécies estudadas possam atuar como dispersoras de sementes, particularmente para macrófitas. Diferenças espaciais intraespecíficas não foram encontradas, exceto para A. fasciatus. A presença de Podostemaceae no curso médio do rio parece ser uma fonte importante de alimento para as espécies, além de servir de refúgio para diversos organismos que são predados por Astyanax sp.

Feeding habits of six species of Astyanax from river Maquiné are described. Fishes were sampled bi-monthly from November/95 to September/96 in two zones of the river. Items were identified, counted and had their abundance estimated according to a semi-quantitative scale. Frequency of occurrence, alimentary importance index (IFI) values and a similarity analysis of diets for each species-river zone sample were examined. All the species were considered typically omnivorous, with insects and vegetal matter being the most important items in their diet. These species could act as seed dispersers, particularly for macrophytes. Intra-specific spatial differences were not observed in comparisons of samples from two diferent regions of the river, except for A. fasciatus. The presence of Podostemaceae macrophytes in the mid-course of the river seemed to be important both as an autochthonous food resource and as habitat for several organisms preyed by the Astyanax species.