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The purpose of this manuscript is to review published literature regarding the role of OCT in the preoperative evaluation of candidates to cataract surgery with MIOL and the postoperative impact these IOL can have in OCT evaluation of the posterior segment. We also update current knowledge about MIOL use in glaucoma patients and the effect this IOL technology can have in visual field assessment after surgery. Furthermore, we present our data regarding a small group of patients with healthy eyes who underwent phacoemulsification and implantation of a MIOL: extended depth of focus TECNIS Symfony (Abbott Medical Optics, Santa Ana, USA) or trifocal Finevision (PhysIOL, Liége, Belgium). We analyzed the results of postoperative macular imaging using Cirrus HD-OCT 4000 (Carl Zeiss Meditec, Jena, Germany) and postoperative automated perimetry testing with Humphrey Visual Field 30-2, SITA-standard (Carl Zeiss Meditec)., Revista Sociedade Portuguesa de Oftalmologia, Vol. 40 N.º 3 (2016)

This paper is concerned with the stability assessment of Rossio railway tunnel, located in Lisbon metropolitan area, during its rehabilitation phase. Built in the nineteenth century, the 2.6-km long Rossio tunnel was constructed in the old central area of Lisbon for providing goods and services for the users of railway services. On several occasions, the breakdown of tunnel lining together with water inrush has caused total disruption of traffic operations resulting in necessary comprehensive rehabilitation of the tunnel. Almost 50% of the original brick support lining has been replaced by 50-cm thick reinforced concrete arches. In order to monitor the efficacy of both the new and the old support systems, a new special monitoring method was applied, using a perimeter bar extensometer incorporating fibre optics strain sensors together with an automatic convergences data acquisition and processing system for detecting abnormal roof displacements.

This note intends to approach the mechanical characterization of rock joints, emphasizing the application of pull tests, which are an economic and simple type of shear experiments. Explanation is given on the drawbacks resulting from the classical testing procedures which do not control the sample’s middle plane position, leading to normal scale effects (represented by negative exponential regressions), where small sample results are misleading in terms of safety. In effect, pull tests allow a very easy measurement of several joint properties, such as the so-called joint roughness coefficient, the slope of joint roughness, the roughness anisotropy, and joint strengths under low normal stresses. Some rules for their standardization are suggested by pointing out the systematic leveling of the middle joint sample plane, thus rehabilitating the interest on small samples, because of the inverse scale effects on strength that are obtained, represented by positive exponential regressions.

Kaiser effect was noticed while submitting marble samples to Brazilian tests. An automatic data acquisition system was applied by means of analog to digital conversion, upon recording analog signals of stress, strain and acoustic emission (AE) emitted from Portuguese marble specimens under diametrical loadings in different loading cycles. Results confirm that the Kaiser effect was pronounced and was easy to be detected under Brazilian tests with a felicity ratio varied from 0.92 to 1.09. This means it is possible to measure the pre-existing stresses in rocks under complex states of stress by means of other tests besides uniaxial compression. Results also show that cumulative AE events vs. stress curve is more suitable for Kaiser effect recognition than cumulative AE energy vs. stress curve as every event has different scales of energy.

This paper presents the outcome of a feasibility study on underground coal gasification (UCG) combined with direct carbon dioxide (CO2)capture and storage (CCS) at a selected site in Bulgaria with deep coal seams (>1,200 m). A series of state-of-the-art geological,geomechanical, hydrogeological and computational models supported by experimental tests and techno-economical assessments have been developed for the evaluation of UCG-CCS schemes. Research efforts have been focused on the development of site selection requirements for UCG-CCS, estimation of CO2 storage volumes, review of the practical engineering requirements for developing a commercial UCG-CCS storage site, consideration of drilling and completion issues, and assessments of economic feasibility and environmental impacts of the scheme. In addition, the risks of subsidence and groundwater contamination have been assessed in order to pave the way for a full-scale trial and commercial applications. The current research confirms that cleaner and cheaper energy with reduced emissions can be achieved and the economics are competitive in the future European energy market. However the current research has established that rigorous design and monitor schemes are essential for productivity and safety and the minimisation of the potential environmental impacts. A platform has been established serving to inform policy-makers and aiding strategies devised to alleviate local and global impacts on climate change, while ensuring that energy resources are optimally harnessed.

There is a gap in international guidelines for acceptable wait times for cardiovascular surgery. Most patients benefit from surgery as fast as possible after the establishment of an indication. However due to extrinsic factors a continuous and cost-effective response is not feasible to all of them. Priority criteria for surgery after the indication is heterogeneous. The physician/surgeon is responsible for the surgical prioritization upon experience-based criteria. The prioritization is accepted by the hospitals most of the times, but incorrections are verified in excess and defect. There is a press in need for evidence-based prioritization criteria in cardiac and vascular surgery that maintains an adequate waiting time with maximum benefit. Surgical waiting times superior to what is clinically reasonable affects not only the patient but also the health system by indirect costs (morbidity, absence from work). The objective is to establish recommendations in extra-carotid disease, abdominal aortic disease, peripheral artery disease and vascular access construction. A review from the data is made to define an appropriate balance between the surgical scheduling and the prevention of pre an perioperatory adverse events.

Revista Sociedade Portuguesa de Oftalmologia, Vol. 38 N.º 4 (2014)

Purpose: The external iliac artery has physical characteristics, in particular, caliber and length, similar to those of the renal artery and would thus seem to be an ideal substitute for it. However, there are no studies in the literature designed to confirm this possibility. The present study was designed to demonstrate the feasibility of use of the external iliac artery as a substitute for the renal artery in surgical revascularization of renal artery fibrodysplasia and to assess the long-term biologic behavior of the external iliac artery so used. Methods: Twelve patients (11 female, 1 male), ages 1 to 43 years (mean, 24.4 years), with severe hypertension underwent aortorenal bypass grafting with use of the external iliac artery to treat preocclusive stenotic lesions (n = 7), complete occlusion (n = 3), or aneurysm (n = 2) of the renal artery. It was considered unnecessary to reestablish circulation in the donor limb in 2 patients (young children), and transposition of the ipsilateral internal iliac artery was performed in 9 patients; in the remaining patient circulation was reestablished with insertion of an iliofemoral prosthesis. Results: There were no operative deaths. In 1 patient nephrectomy was necessary because of occlusion of the graft as a consequence of technical complications. In 8 patients there was immediate normalization of blood pressure without aid of medication, and in the remaining 3 patients an antihypertensive drug was prescribed. Two patients were lost to follow-up; the other 9 were assessed with angiography at a mean of 8.8 years after the operation. All grafts were found to be in excellent condition, with no evidence of dilatation, kinking, twisting, anastomotic fibroplasia, or wall irregularities. Conclusion: On the basis of this experience, the external iliac artery is confirmed as a substitute for the renal artery, and the excellent long-term results would seem to make it particularly useful in young patients with long life expectancy, such as those with renal artery fibrodysplasia.

Limit equilibrium models of forces that act on joints in rock masses have a disadvantage in that it is impossible to explicitly integrate joint roughness amplitude because the models consider only the nondimensional parameters related to asperity geometry. However, for adequate joint roughness characterization, it is essential to consider amplitude as well. Thus, the formulation of a limit equilibrium model of the strain energies associated with rock joints is proposed, in which two different joints may yield under the same shear stress while they have asperities with the same slope but different amplitudes, because they actually have different strengths.

A healthy 46-year-old woman presented to our hospital with complaints of sudden and repeated episodes of syncope without accompanying signs or symptoms. Neurological investigation proved negative and a 24-hour Holter monitoring device revealed significant nocturnal cardiac pauses. As such, a pacemaker was implanted in the patient, which was effective at preventing the syncopes. A subsequent investigation led to the undertaking of a cervical computed tomography (CT) scan that showed the existence of a right carotid body tumor. Rotational flexing or stretching of the neck immediately triggered the start of the pacemaker. The tumor was surgically removed and the patient no longer felt the activation of the pacemaker, which was removed 6 months after the operation. One year later, the patient was found to be well and completely free of her previous symptoms.

To compare and repeatedly measure cycloplegic refraction in a cross-section of children using retinoscopy and automated refraction.A total of 560 children (corresponding to 1120 eyes) ranging in age from 3 to 10 years participated in the study. Each child underwent a comprehensive eye examination, which included table mounted autorefractor evaluation (Kowa KW-2000) and streak retinoscopy, both after cycloplegia with 1% cyclopentolate hydrochloride. Data were analyzed using Fourier decomposition of the power profile.More positive values of M component and sphere value were given by cycloplegic autorefraction (AKW) compared with cycloplegic streak retinoscopy (RR). More negative values for the J45 vector and more positive for J0 were given AKW although this difference was not statistically significant.Our study shows that the table mounted autorefkeratometer Kowa KW- 2000 can be applied to young children with cycloplegia as instrument for cycloplegic refraction, and a discount of +0.67 should be applied on the sphere value. Similar care should be taken on the evaluation of the sphere and spherical equivalent values should be applied in other devices.

Lower limb ischemia is a major health problem. Because of the absence of effective treatment in the advanced stages of the disease, amputation is undertaken, even though it is associated to morbidity and mortality. Therefore, novel therapeutic approaches are necessary, aiming at the formation of stable, well-organized and functional blood vessels in ischemic tissues. Recently, we found that low doses of ionizing radiation (IR) promote angiogenesis and we assessed the hypothesis that they may be therapeutically useful in vascular occlusive disease. By using a mouse model of hind limb ischemia we quantified the blood flow expressed as a ratio of ischemic to non-ischemic limb perfusion in irradiated and unirradiated mice at different times and our results suggest that, at 15 days post-ischemia, low-dose IR significantly increases perfusion recovery (p=0.00075; n=6 mice per group). Moreover, a statistically significant increase in the capillary density was noted in ischemic irradiated muscles when compared to ischemic unirradiated ones (p=0.00009; n=6 mice per group). On the contrary, no difference was observed when comparing non-ischemic muscles irradiated or not. These results are representative of at least four independent experiments. From an in vitro microarray data obtained in our lab, we selected the genes whose expression is significantly altered by low doses of IR and that represent the best candidates for a pro-angiogenic response. Their expression was evaluated in endothelial cells isolated from the gastrocnemius muscles from irradiated and unirradiated mice. A laser capture microdissection microscope was used followed by RNA extraction and cDNA synthesis. Several pro-angiogenic genes were preamplified before quantitative RT-PCR analyses. Our results suggest that low-dose IR induces the expression of VERGR1, VEGFR2, FGF2, TGFB2 and ANG2 in endothelial cells isolated from ischemic muscles. In conclusion, our data have the potential to propose a new strategy for neovascularization using low doses of IR. The use of a hind limb ischemia model in larger animals will be fundamental to firmly establish the benefits and exclude any harmful effects, before considering low-dose IR as a valid tool to be used in contemporary human medicine.

Marfan's Syndrome is a rare connective tissue disease whose surgical treatment presents several challenges. The existing criteria and recommendations on how and when to surgically approach this disease is almost exclusively confined to the root and ascending aorta, in contrast to the variability of indications on the involvement of the remaining segments of the thoracic and abdominal aorta, due to the multiplicity, morphology and topography of these involvements. This case report is related to a 39 year old woman with Marfan's syndrome, with a type B chronic dissection and a segmentar aneurysm of the proximal descending thoracic aorta with 6,1cm of maximum diameter. The clinical and imagiologic evaluation pointed out the absence of any disorder of the heart, root or ascending aorta. The patient underwent surgical management of the dissecting aneurysm through a transthoracic approach to the aneurysm, with fenestration of the distal aorta and exclusion of the aneurism and intercostal arteries. The efficacy and result of the procedure in addition to the rarity of the vascular pathology presented by the patient, even in the context of a Marfan, completely justify the presentation and disclosure of this clinical case.

A 26-year-old woman, complained of repeated urinary infections at the beginning of February 2010. Several urine sample tests identified an Escherichia colli strain, which was treated with antibiotics, according to the antibiogram data. Shortly afterwards, as a result of a back pain, a pyelonephritis was diagnosed, which was also treated with antibiotics. The pain progressively intensified over time and in June 2011 she began to suffer from high and persistent fever, which led to her hospitalisation. The investigation through CT-angiography showed the existence of three aneurysms of the thoracic aorta (one of the aortic arch and two of the descending thoracic aorta) and a large aneurysm of the abdominal aorta, in a contained rupture, surrounding the origin of the renal arteries, of infectious etiology. The patient underwent three sequential and successful surgical operations, using the conventional approach that consisted in the resection and replacement of the aneurysms with "in situ" vascular prosthesis. The main aspects of the pathology, clinical presentation and treatment of this extensive, rare and challenging situation are presented and discussed herein.

Adult congenital aortic coarctation is an entity rarely seen in clinical practice. It is commonly diagnosed and managed in the early stages of life, mean in the neo-natal or young children's ages. Some cases however can be overlooked at this scrutinity and become recognizable at later stages, in adulthood, through symptoms and signs resulting from the deep hemodynamic deregulation caused by the disease in the proximal and distal aortic physiology, requiring often imperative therapeutic repair. In this paper, an extensive revision is made on the main pathologic, clinical and diagnostic features of the disease, culminating in a critical analysis on the contemporary therapeutic methods available, which includes the conventional open surgery and the endovascular intervention, which includes the balloon angioplasty, the stenting and the covered stents.

The clinical case of a 46 years old male is reported, who complained of a sudden and sharp epigastric pain, with no other accompanying symptoms or signs. The patient was evaluated in the emergency department of a local hospital and the clinical and laboratory analysis excluded the occurrence of a common acute abdominal pathology. A CT and an angio CT study disclosed a spontaneous dissection and aneurismal dilatation of the celiac axis, along its extension. The patient underwent surgical management, consisting in the resection and prosthetic replacement of the celiac axis and the pathological studies of the specimen revealed a fibromuscular dysplasia, which seems to be, according to the literature, an exceptional situation, never reported before, thus justifying its publication and dissemination.

The clinical case of a 72-years old male is reported, admitted into a Medical Department through the Emergency Service, with a clinical picture of heavy lumbar pain, with walking compromise and acute urinary retention, lasting for several hours. Laboratory analysis revealed a marked elevation of acute inflammatory parameters and a renal failure, expressed by 108 mg/dl of urea and 4.4 mg/dl of creatinine. The patient was admitted with the provisional diagnosis of acute prostatitis, pos-renal acute renal insufficiency and dorso-lumbar pathology of unknown etiology. Three consecutive and subsequent hemocultures allowed the isolation of a Streptococcus pneumonae strain and a CT dorso lumbar spine evaluation disclosed a D11 to D12 spondylodiscitis, with a partial destruction of the vertebral bodies and an extensive throracoabdominal aortic aneurysm adjacent to those vertebrae, with some characteristic features of an infectious aneurysm. Simultaneously, an hemothorax on the left chest was noticed, consequence of a chronic contained rupture of the aneurysm. Following an intensive and specific antibiotic therapy and with an almost completed recovery of the renal function, he underwent surgical management, consisting in the evacuation and drainage of the hemothorax, followed by resection of the aneurysm and extensive tissular debridmente, culminating in the vascular reconstruction utilizing the "simplified technique", introduced in 1984 by A. Dinis da Gama for the surgical management of thoracoabdominal aortic aneurysms. The patiente tolerated the procedure well, with no intercorrences or complications and the post operative course was unventfull. One month later, a CT-angio control disclosed the revascularization procedure working in excellent condition. Finally, an orthopedic artrodhesis of the injuried vertebrae was performed, allowing an easy and pain-free walking and he was discharged on day 60, under antibiotic treatment. The main features of this clinical case are emphasized and discussed, namely those aspects related to its pathogenesis, clinical presentation, diagnosis and surgical management.