RESUMO. Avaliou-se, prospectivamente, o manejo dos sistemas de drenagem torácica fechada em pacientes adultos no Hospital Universitário de Maringá, Estado do Paraná, no período de dez meses. Foram acompanhadas 90 drenagens em 75 pacientes. Predominou a causa traumática em pacientes jovens como determinante de indicação da drenagem pleural (61/90, 68%). A falta do curativo em meso e contrameso, como fixação complementar do dreno, foi a ocorrência isolada mais comum no manejo, sendo encontrado rotineiramente em 20% (18/90). A presença de obstrução (por dobramento, sifonagem, coágulo ou fibrina) esteve presente em 12% das drenagens (11/90) e complicações (enfisema subcutâneo, infecção, deslocamento acidental, pneumotórax na retirada do dreno) em 21% (20/90). O manejo apropriado da drenagem torácica reduz a morbidade associada ao método. Esta pesquisa ressalta a importância do treinamento continuado e do estabelecimento de manuais que padronizem condutas para os profissionais da saúde que manejam o sistema de drenagem torácica.Palavras-chave: drenagem, tubos torácicos, toracostomia, cavidade pleural, cirurgia torácica.ABSTRACT. Care with the thoracic drainage system in adults at the Universitary Hospital of Maringá, Paraná State, Brazil. The handling of adults' closed thoracic drainage systems at the University Hospital of Maringá, Maringá, Paraná State, Brazil during a 10-month period was prospectively evaluated. Ninety thoracic drainages in 75 patients were analyzed. Traumatic causes in young patients determined pleural drainage (61/90, 68%). The absence of an omental tag of tape as a complementary tube fixation was the most common, albeit isolated case, occurrence in the procedure. In fact, it has been routinely found in 20% (18/90) of cases. Whereas tube obstruction (due to kinking, siphoning, clotting or fibrin) was detected in 12% (11/90) of drainage cases, drainage complications (subcutaneous emphysema, infection, accidental dislodgement, pneumothorax following chest tube removal) occurred in 21% (20/90) of cases. Adequate handling of tube thoracostomy reduces morbidity related to this procedure. Current research enhances the importance of continuous training and of textbooks that would standardize procedures for health teams whose role involves interventions in the thoracic drainage system.

Horseshoe kidney is one of the most common urologic anomalies, present in about 0.12% of patients with abdominal aortic aneurysm. Conventional surgical repair is associated with technical difficulties that probably increase morbidity and mortality but can be avoided with endovascular treatment. We report the case of a 64-year-old patient presenting with horseshoe kidney and abdominal aortic aneurysm and successfully treated with endovascular repair.Keywords: abdominal aortic aneurysm; congenital abnormalities; blood vessel prosthesis implantation. ResumoO rim em ferradura é uma das anomalias urológicas congênitas mais comuns e está presente em cerca de 0,12% dos pacientes com aneurisma de aorta abdominal. O reparo cirúrgico convencional está associado a dificuldades técnicas que provavelmente aumentam a morbidade e a mortalidade, mas que podem ser evitadas com o tratamento endovascular. Relatamos um caso de um paciente de 64 anos com rim em ferradura e aneurisma de aorta abdominal, que foi submetido ao reparo endovascular do aneurisma com sucesso.Palavras-chave: aneurisma de aorta abdominal; anormalidades congênitas; implante de prótese vascular.

Correct identification and early management of hypertensive disorders should be a part of the therapeutic repertoire of every professional working in hemodynamics units. Based on recent publications, this study aims to propose a practical approach to the identification and early management of these disorders in this type of service.

Descrevemos um caso de oclusão arterial aguda por projétil de arma de fogo. Devido à raridade do caso (23 relatos em 20 anos) e a importância do diagnóstico diferencial precoce, uma revisão bibliográfica foi realizada. Foram abordados aspectos do quadro clínico, diagnóstico diferencial e tratamento. Neste caso, o diagnóstico por meio de ultrassom vascular da complicação foi publicado pela primeira vez.

The authors describe the cases of two patients with pseudoaneurysms, discuss the difficulty in establishing diagnosis and treatment due to human immunodeficiency virus infection, and demonstrate the similarity with atherosclerotic saccular aneurysm of the abdominal aorta.Keywords: HIV; pseudoaneurysm; saccular aneurysm. ResumoOs autores descrevem os casos de dois pacientes que apresentaram pseudoaneurismas e ressaltam a dificuldade diagnóstica e terapêutica por apresentar associação com a infecção pelo vírus da imunodeficiência humana, e também demonstram a semelhança com aneurisma sacular aterosclerótico da aorta abdominal.Palavras-chave: HIV; pseudoaneurisma; aneurisma sacular. As the patient was obese, had previous abdominal surgery and her anatomy was favorable, the plan was to use an endovascular approach to place an aortic endoprosthesis for aneurysm repair.Right femoral dissection and left femoral puncture were used to place a 25 mm × 16 mm × 100 mm Powerlink R endoprosthesis (Endologix, Irvine, CA) using a 9F introducer sheath, and the aneurysm was immediately repaired. Post-operative progression was good, and the patient was discharged on the second day after operation. Ten days after the operation, she presented with left lower back pain, diarrheic stools, vomiting and paresthesia of left lower extremity. Physical examination detected femoral and distal pulses and no sign of hyperemia in the surgical wound; laboratory tests were normal. Two days after hospitalization, her general state deteriorated and she had abdominal and lower extremity pain. Physical examination found that the lower extremities were cold, and no pulses should be detected. Ultrasound scanning confirmed the clinical hypothesis of endoprosthesis occlusion. She underwent an urgent surgery for an axillobifemoral bypass and placement of an 8-mm Dacron prosthesis, and revascularization of the lower extremities was successful. After operation in the ICU, she was administered broad spectrum antibiotics (vancomycin 1 g, 12h/12h and meropenem 1 g, 8h/8h), but had refractory septic shock and died. Case 2A previously healthy 47-year-old male smoking patient was transferred from another hospital ward with a history of daily low fever for 20 days. Nine