Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.

Vegetation mapping in an area of Ombrophilous Dense Forest at Parque Estadual da Serra do Mar, São Paulo State, Brazil, and floristic composition of the tree component of some physiognomies*

This study aimed to map phytophysiognomies of an area of Ombrophilous Dense Forest at Parque Estadual da Serra do Mar and characterize their floristic composition. Photointerpretation of aerial photographs in scale of 1:35,000 was realized in association with field work. Thirteen physiognomies were mapped and they were classified as Montane Ombrophilous Dense Forest, Alluvial Ombrophilous Dense Forest or Secondary System. Three physiognomies identified at Casa de Pedra streamlet's basin were studied with more details. Riparian forest (RF), valley forest (VF), and hill forest (HF) presented some floristic distinction, as confirmed by Detrended Correspondence Analysis (DCA) and Indicator Species Analysis (ISA) conducted here. Anthropic or natural disturbances and heterogeneity of environmental conditions may be the causes of physiognomic variation in the vegetation of the region. The results presented here may be useful to decisions related to management and conservation of Núcleo Santa Virgínia forests, in general.

Revision of Neodischistus Painter, 1933 (Diptera, Bombyliidae, Bombyliinae)

The Neotropical genus Neodischistus Painter has a distribution restricted to South (Brazil and Argentina) and Central America (Panama). The genus is composed of two previously described species that are herein revised: N. currani Painter and N. collaris Painter. One new Brazilian species is described: N. marstoni sp. nov. Illustrations of the external morphology of adults and male and female terminalia are also included. An identification key to the species is presented and a short discussion about species distributions is added.

Revision of the Neotropical genus Carrerapyrgota Aczel (Diptera, Pyrgotidae) with the description of two new species

The Neotropical genus Carrerapyrgota Aczel is restricted to the South America (Brazil and Argentina). The genus is composed of two previously described species, which are revised herein: C. miliaria Aczel and C. personata (Lutz & Lima). Two new Brazilian species are described: C. aczeli from Sao Paulo and C. bernardii from Bahia. Illustrations of the external morphology of adults and male and female terminalia are also included. An identification key to the species is presented, as well as a brief discussion of the biology and distribution of the genus.

Two new species of Paraehlersia San Martin, 2003 (Polychaeta, Syllidae) from the Atlantic Coast of South America

Paraehlersia San Martin, 2003 is reported for the first time for the Atlantic coast off South America based on specimens collected off Brazil and Argentina. The specimens belong to two new species, which are herein described. Paraehlersia longichaetosa sp. nov., is characterized by having spiniger-like chaetae with long blades, up to 120 mu m in length, bidentate anterior falcigers, with relatively coarse subdistal tooth, bidentate dorsal simple chaetae, with teeth about same size, and subdistally irregularly inflated aciculae, apparently hollow, with acute tip. Paraehlersia martapolae sp. nov., has spiniger-like chaetae with shorter blades, up to 82 mu m in length, bidentate falcigers, with thin subdistal tooth, distally irregularly rounded dorsal simple chaetae, and aciculae subdistally bent at almost right angle, sometimes with apparently flattened top. These new species are compared to their most similar congeners. Additionally, a table summarizing relevant morphological traits of all currently known species of Paraehlersia is included.

On some species of Taeniotes Audinet-Serville, 1835 (Coleoptera: Cerambycidae: Lamiinae)

Taeniotes farinosus (Linnaeus, 1758) is a species that has been confused with other species during the past two centuries. In this work we demonstrate that Taeniotes farinosus sensu auctorum is not the species described by Linnaeus and designate a lectotype to establish its identity. Taeniotes pulverulentus (Olivier, 1790), currently synonymous with T. farinosus, is revalidated. Taeniotes guttullaris Schwarzer, 1929 and T parafarinosus Breuning, 1971 are junior synonyms of T. pulverulentus; Lamia subocellata Olivier, 1792 (= Taeniotes subocellatus) is a junior synonym of Cerambyx farinosus (= T farinosus). Additionally we monnei, a new species from Brazil and Argentina, is described and figured. Taeniotes peruanus provide annotated bibliographic references to T. farinosus and T pulverulentus. Taeniotes Breuning 1971 is figured for the first time.

Relationship between sweet orange yield and intensity of Citrus Variegated Chlorosis

Citrus Variegated Chlorosis (CVC) is currently present in approximately 40% of citrus plants in Brazil and causes an annual loss of around 120 million US dollars to the Brazilian citrus industry. Despite the fact that CVC has been present in Brazil for over 20 years, a relationship between disease intensity and yield loss has not been established. In order to achieve this, an experiment was carried out in a randomized block design in a 3 x 2 factorial scheme with 10-year-old Natal sweet orange. The following treatments were applied: irrigation with 0, 50 or 100% of the evapotranspiration of the crop, combined with natural infection or artificial inoculation with Xylella fastidiosa, the causal agent of CVC. The experiment was evaluated during three seasons. A negative exponential model was fitted to the relationships between yield versus CVC severity and yield versus Area Under Disease Progress Curve (AUDPC). In addition, the relationship between yield versus CVC severity and canopy volume was fitted by a multivariate exponential model. The use of the AUDPC variable showed practical limitations when compared with the variable CVC severity. The parameter values in the relationship of yieldCVC severity were similar for all treatments unlike in the multivariate model. Consequently, the yieldCVC intensity relationship (with 432 data points) could be described by one single model: y = 114.07 exp(-0.017 x), where y is yield (symptomless fruit weight in kg) and x is disease severity (R2 = 0.45; P < 0.01).

Suicide rates and income in Sao Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Background: In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of Sao Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods: Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results: Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions: Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.

Metropolitan and regional health planning: dilemmas of the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil

This paper focuses on the relationship between metropolitan and regional health planning based on the processes of regionalization and the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil. The method used was a case study in two stages, namely during initial implementation of the Pact for Health (2007) and the Regional Administration Committees (CGR) and in 2010. Municipal and regional health systems managers and the director of the Metropolitan Agency were interviewed, and records were analyzed from ten years of meetings of the Regional Inter-Administration Committee and the Regional Development Council. Four issues emerged: financing and infrastructure; health services utilization; inefficiency of the Regional Health Administration's instruments and decision-making levels; and the relationship between different levels in the Administration. Metropolitan health management remained as an underlying issue, appearing only incidentally or tangentially to regional management. Despite some limitations, the CGR has been legitimized as a space for regional health management.

Virulence and molecular aspects of Bordetella avium isolated from cockatiel chicks (Nymphicus hollandicus) in Brazil

Bordetella avium is an opportunistic pathogen that presents tropism for ciliated epithelia, leading to upper respiratory tract disease in turkeys. This agent has also been associated with Lockjaw Syndrome in psittacine birds, but literatures describing the importance of this agent in such species are rare. The purpose of the present study was to report the first outbreak of B. avium infection in juvenile cockatiels demonstrating the Lockjaw Syndrome in Brazil and to investigate the antimicrobial resistance profile and phenotypic and genotypic characteristics of these strains. Surprising, the strains obtained from five infected cockatiel chicks from three different breeders from different Brazilian states showed a clonal relationship using the Pulsed Field Gel Electrophoresis and Single Enzyme Amplified Fragment Length Polymorphism techniques. The virulence potentials of the B. avium strains were assessed using tracheal adherence and cytotoxic effects on a VERO cell monolayer. (C) 2012 Elsevier B.V. All rights reserved.

Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Abstract Background In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.

Population biology of Excirolana armata (Dana, 1853) (Isopoda, Cirolanidae) on an exposed sandy beach in Southeastern Brazil

The reproductive biology and population dynamics of the cirolanid isopod Excirolana armata (Dana, 1853) were analysed through monthly samples from December 2003 to November 2005 on Una beach, Sao Paulo state (24 degrees S), in Southeastern Brazil. Sampling was performed along three transects established from the base of foredunes to the waterline. On Una beach, E. armata showed continuous reproduction with higher abundances of ovigerous females in winter and spring (July-November) with a higher peak of juveniles in spring (November 2004). The fecundity ranged from 2 to 18 eggs/embryos per female, depending on the female length. The incubation period was estimated as 2 months. The life span of males and females was nearly 1 year. The short life span and the high energetic expenditure inherent to reproduction with maternal care, probably kept females from producing more than one brood in their lifetime. When comparing the population of E. armata on Una beach (24 degrees S) with populations in Southern Brazil (32 degrees S), Uruguay (34 degrees S) and Argentina (36 degrees S), it was verified that several biological population traits (length of the smallest juvenile, length of the largest individual, length of the smallest and largest ovigerous females, range of fecundity and life span) tended to increase at higher latitudes, whereas other traits (instantaneous rate of mortality and the curvature parameter of von Bertalanffy growth function) tended to decrease. However, comparing E. armata on Una beach (24 degrees S) with a population situated at a close latitude (25 degrees S), unexpected differences in relation to population structure and to growth demonstrated and reinforced the importance of density-dependent factors over life history traits of E. armata on dissipative beaches.

Levels of persistent organic pollutants and residual pattern of DDTs in small cetaceans from the coast of Sao Paulo, Brazil

The State of Sao Paulo is the most developed area in Brazil and was impacted by persistent organic pollutants for several decades. This study investigated organochlorines in five species of small cetaceans (Pontoporia blainvillei, Stenella frontalis, Sotalia guianensis, Tursiops truncatus and Steno bredanensis) found dead along the coast of Sao Paulo between 1997 and 2003. DDTs (15.9 mu g g(-1) lipid: mean for all pooled individuals) and PCBs (8.08 mu g g(-1)) exhibited the highest concentrations in the animals, reflecting large amounts formerly used in Brazil. Lower levels of mirex (0.149 mu g g(-1)), HCB (0.051 mu g g(-1)), CHLs (0.008 mu g g(-1)) and HCHs (0.007 mu g g(-1)) were detected in all species. Residual pattern of DDTs in dolphins suggests that o,p`-DDT is more recalcitrant than p,p`-DDT in the body of the animals and/or the environment. In contrast to p,p`-DDT, residues of o,p`-DDT seem to be preferentially converted into o,p`-DDD rather than op-DDE. (C) 2010 Elsevier Ltd. All rights reserved.

Metals and semi-metals in street soils of So Paulo city, Brazil

So Paulo is the largest city in Brazil and South America with about 20 million inhabitants in the metropolitan area, more than nine million motor vehicles and intense industrial activity, which are responsible for increasing pollution in the region. Nevertheless, little is known concerning metal and semi-metal content in the soils of this metropolitan region. This type of information could be extremely useful as a fingerprint of environmental pollution. The present study determined the elements As, Ba, Co, Cr, Sb, and Zn concentrations in soils adjacent to avenues of highly dense traffic in So Paulo city to assess their levels and possible sources. The analytical technique employed was Instrumental neutron activation analysis. The results showed, except for Co, concentration levels higher than the reference values for soils of So Paulo, according to the Environmental Protection Agency of the State of So Paulo guidelines. When compared to similar studies in other cities around the world, So Paulo soils presented higher levels, probably due to its high density traffic and industrial activity. The concentrations obtained for As and Cr indicate anthropogenic origin. The high levels of the traffic-related elements Ba, Sb, and Zn in soils nearby high density traffic avenues indicate they may originate from vehicular exhausts.

Accumulation of six metals in the mangrove crab Ucides cordatus (Crustacea: Ucididae) and its food source, the red mangrove Rhizophora mangle (Angiosperma: Rhizophoraceae)

The crab Ucides cordatus and the red mangrove Rhizophora mangle are endemic mangrove species and potential bio-accumulators of metals. This study quantified the accumulation of six metals (Cd, Cr, Cu, Hg, Mn and Pb) in different organs (claw muscle, hepatopancreas and gills) of U. cordatus, as well as in different maturation stages of the leaves (buds, green mature, and pre-abscission senescent) of R. mangle. Samples were collected from mangrove areas in Cubatao, state of Sao Paulo, a heavily polluted region in Brazil. Data for metal contents in leaves were evaluated by one-way ANOVA; while for crabs a factorial ANOVA was used to investigate the effect of different tissues, animal size and the interactions between them. Means were compared by Tukey test at five percent, and the association between the metal concentrations in each crab organ, depending on the size, was evaluated by Pearson's linear correlation coefficient (r). Concentrations of Pb and Hg were undetectable for the different leaf stages and crab tissues, while Cd concentrations were undetectable in the leaf stages. In general, the highest accumulation of metals in R. mangle leaves occurred in pre-abscission senescent and green mature leaves, except for Cu, which was found in the highest concentrations in buds and green mature leaves. For the crab, Cd, Cu, Cr and Mn were present in concentrations above the detection limit, with the highest accumulation in the hepatopancreas, followed by the gills. Cu was accumulated mostly in the gills. Patterns of bioaccumulation between the crab and the mangrove tree differed for each metal, probably due to the specific requirements of each organism for essential metals. However, there was a close and direct relationship between metal accumulation in the mangrove trees and in the crabs feeding on them. Tissues of R. mangle leaves and U. cordatus proved effective for monitoring metals, acting as important bioindicators of mangrove areas contaminated by various metals. (C) 2012 Elsevier Inc. All rights reserved.