Anorectal leiomyomas: report of two cases with different anatomical patterns and literature review

Gastrointestinal mesenchymal tumors comprise a rare group of gastrointestinal tract wall tumors that have long been a source of confusion and controversy, especially in terms of pathological classification, preoperative diagnosis, management strategies, and prognosis. This report describes the clinical manifestations and management of 2 rectal leiomyomas and reviews the pertinent literature. Case 1: A 44-year-old woman was admitted reporting a nodule in the right para-anal region for the previous 2 years. At proctological examination, a 4-cm diameter fibrous mass situated in the para-anal region that produced an arch under the smooth muscle on the right rectal wall just above the anorectal ring was noted. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed the lesion and detected no other abnormalities. Surgical treatment consisted of wide local resection of the tumor through a para-anal incision, with no attempts to perform lymphadenectomy. Case 2: A 40-year-old male patient was admitted reporting constant anal pain for 4 months. He presented a 3-cm submucosal nodule at the anterior rectal wall just above the dentate line. After 2 inconclusive preoperative biopsies, transanal resection of the tumor was performed. Histological analysis of the specimen showed a benign leiomyoma. A review of the literature is presented, emphasizing some clinical and therapeutic aspects of this unusual rectal tumor.

Description of behavioral patterns of Podocnemis erythrocephala (Spix, 1824) (Testudines: Podocnemididae) (Red-headed river turtle) in captivity, Manaus, Amazonas, Brazil

The biology and ecology of South American turtles is still poorly known, particularly, for the Brazilian species. Laboratory studies are essential to understand the life cycles of aquatic turtles species and to help in formulating management plans for their conservation. As a contribution to the knowledge of Podocnemis erythrocephala species, we give a description of its species-typical behaviors, categorized as: maintenance, locomotion, feeding, agonistic and reproduction, based on captives observations of four pairs of turtles in an aquarium in Manaus, Brazil. Similarities and differences with the repertoires of other turtle species are discussed, concluding that turtles have much more complex adaptative strategies and social life than was believed.

Diversity of sand flies in domiciliary environment of Santarém, state of Pará, Brazil: species composition and abundance patterns in rural and urban areas

This paper aimed to evaluate the richness, abundance and frequency of sand fly occurrence in rural and urban areas American visceral Leishmaniasis -AVL is endemic in the study area of Santarém municipality, Pará state. Sand flies were collected during 1995-2000, using CDC light traps placed in neighborhoods and rural areas of the municipality. A total of 53.454 individuals and 26 species of sand flies were collected. The most abundant species in both urban and rural environments was Lutzomyia longipalpis, vector of AVL in the area. The highest species richness by capture was in rural area. In all years sampled, the largest number of species of sand fly collected was always in rural areas. The species of sand flies in urban and rural area were similar in 11 species. In the rural area other 11 species were found, a total of 22 species. Shannon-Wiener index ranged from 0.12 to 0.84 at rural areas and 0.08 to 0.34 at urban ones. In general, rural localities showed higher diversity (H') of phlebotomines than urban ones. Individual-based rarefaction curves for each area demonstrated that urban localities had the lowest expected number of phlebotomine species and the richest rural ones reach higher expected values with lower amount of individuals than urban sites. The most frequent species were Lutzomyia longipalpis, Evandromyia carmelinoi and Bichromomyia flaviscutellata.

Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients

OBJECTIVE: To identiy left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS: We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension.. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS: We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS: Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.

Distribution of cardiac geometric patterns on echocardiography in essential hypertension. Impact of two criteria of stratification

PURPOSE: To evaluate 2 left ventricular mass index (LVMI) normality criteria for the prevalence of left ventricular geometric patterns in a hypertensive population ( HT ) . METHODS: 544 essential hypertensive patients, were evaluated by echocardiography, and different left ventricular hypertrophy criteria were applied: 1 - classic : men - 134 g/m² and women - 110 g/m² ; 2- obtained from the 95th percentil of LVMI from a normotensive population (NT). RESULTS: The prevalence of 4 left ventricular geometric patterns, respectively for criteria 1 and 2, were: normal geometry - 47.7% and 39.3%; concentric remodelying - 25.4% and 14.3%; concentric hypertrophy - 18.4% and 27.7% and excentric hypertrophy - 8.8% and 16.7%, which confered abnormal geometry to 52.6% and 60.7% of hypertensive. The comparative analysis between NT and normal geometry hypertensive group according to criteria 1, detected significative stuctural differences,"( *p < 0.05):LVMI- 78.4 ± 1.50 vs 85.9 ±0.95 g/m² *; posterior wall thickness -8.5 ± 0.1 vs 8.9 ± 0.05 mm*; left atrium - 33.3 ± 0.41 vs 34.7 ± 0.30 mm *. With criteria 2, significative structural differences between the 2 groups were not observed. CONCLUSION: The use of a reference population based criteria, increased the abnormal left ventricular geometry prevalence in hypertensive patients and seemed more appropriate for left ventricular hypertrophy detection and risk stratification.

Block of the Mitral-pulmonary Isthmus During Ablation of a Single Left-sided Accessory Pathway Causing Different Patterns of Retrograde Atrial Activation

The case of a 16-year-old patient with atrioventricular tachycardia caused by a single left anterolateral accessory pathway is reported. When the patient underwent radiofrequency ablation, a lesion on the mitral annulus lateral wall produced changes in the retrograde atrial activation pattern determined by that pathway; changes ranged from a delay in depolarization of the annulus posterior portions to full left atrium counterclockwise activation. Such phenomena were probably caused by a block in the isthmus between the annulus and the lower left pulmonary vein ostium. This case illustrates the importance of the mitral-pulmonary isthmus in the process of left atrium activation, an alert to changes induced by its unintentional block during accessory pathway ablation.

A Comparison of Radiation Dose Between Standard and 3D Angiography in Congenital Heart Disease

Background: The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available. Objectives: The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA). Methods: Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP). Results: The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m2 and 190µGy.m2 for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m2 vs.413µGy.m2, p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m2 vs.1238 µGy.m2, p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m2 vs.81µGy.m2, P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m2, respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions. Conclusions: The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA.

The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure

AbstractBackground:Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation.Objectives:To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure.Methods:We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the “gold standard” for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings.Results:Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects.Conclusion:Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed.

Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? – Analysis of 568 Patients

Background:Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention.Objective:To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedureMethods:The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated.Results:A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm2, while the staged group, to 139.2 ± 75.3 Gycm2 (p < 0.001).Conclusion:Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.

Production and quality of cotton fibers in relation to solar radiation

The present paper refers to a research work carried out at the Dept. of Agriculture and Horticulture of ESALQ, University of São Paulo, in Piracicaba, State of São Paulo (latitude 22º42'S, longitude 47º33' WG and altitude 546 m). Sowing at different times and using artificial cover, an attempt was made to evaluate the behavior of cultivar IAC 17 of cotton (Gossypium hirsutum L.) as to production and quality of fiber relating to incident solar radiation. Incident solar radiation, as well as insolation during the trial period, were tabulated and compared with yelds and agricultural and technological characters of fibers. The treatment under cover showed a mean level of incident solar radiation equivalent to less than 20% of that at clear sky, causing a decrease in cotton production and in the agricultural and technological characters of fibers.

Infaunal recruitment patterns in soft bottom habitats of the Patos Lagoon estuary, southern Brazil: influence of Chasmagnathus granulata (Brachyura, Grapsidae) disturbance

A comparative study of the infaunal recruitment patterns among disturbed surface sediment mounds around Chasmagnathus granulata Dana, 1851 burrows and undisturbed adjacent sediments was done in two intertidal soft bottom habitats (an upper and a lower mudflat zone) in an estuarine inlet of Patos Lagoon, southern Brazil. The most abundant infaunal organisms were recruits of the polychaete Laeonereis acuta Treadwell, 1923 and of the tanaid Kalliapseudes schubartii Mañé-Garzón, 1949. The densities of these species did not differ significantly between upper and lower mudflat habitats. These species showed lower densities around crab burrows than in adjacent areas, where differences in sediment characteristics were observed as well. The results indicate that C. granulata disturbances may play an important role in regulating the soft bottom benthic community by controlling infaunal recruitment in the estuarine intertidal mudflats of the Patos Lagoon.

Anurans of the Serra do Caraça, southeastern Brazil: species composition and phenological patterns of calling activity

Annual patterns of calling and breeding activity of 38 anuran species were studied at Serra do Caraça, an 11,233 ha reserve located in a contact zone between Cerrado and Atlantic forest at the southern Espinhaço range, southeastern Brazil. Five patterns were evident: (1) species that call year-round or nearly year-round with larger aggregations generally observed in the rainy months, (2) species with opportunistic calling activity associated with rainfall during the wettest months of the year, (3) winter species, (4) explosive breeders with intense calling activity triggered by heavy rains during the rainy season or only in the beginning of the rainy season, and (5) summer species with variable breeding seasons. Both the monthly number of species with calling males and the monthly number of species that showed the maximum class of calling males were positively correlated with both mean monthly temperature and monthly precipitation.

Novelties from a cave lace bug (Heteroptera, Tingidae): first nymphal description with a discussion on the morphological patterns of Vianaidinae immatures

A nymph of Thaumamannia Drake & Davis, 1960, a rare vianaidine genus known only from adults, is described by the first time. The specimens were collected in the soil and walls of caves located in the state of Pará, Brazil. This is the first record of Vianaidinae for Brazil. The T. vanderdrifti fifth instar is compared with the same stadium of Anommatocoris coleopteratus (Kormilev, 1955), the only other vianaidine nymph described so far, and patterns between them and within the family are also discussed.

Composition and ecological patterns of snake assemblages in an Amazon-Cerrado Transition Zone in Brazil

ABSTRACT The present study encompasses the species composition and ecological characteristics of the snake community in a Cerrado-Amazon transition zone in Midwest of Brazil (state of Mato Grosso). The data were collected during six excursions to the "Tanguro" (study area) by visual encounter survey, pitfall traps with drift fences and non-systematic sampling. We collected 194 specimens, distributed in 34 species, 26 genera, and eight families. The most abundant species were Crotalus durissus Linnaeus, 1758 (n = 50), Philodryas olfersii (Lichtenstein, 1823) (n = 15), Philodryas nattereri Steindachner, 1870 (n = 13), Xenodon rabdocephalus (Wied, 1824) (n = 12), Lachesis muta (Linnaeus, 1766) (n = 10) and Erythrolamprus almadensis (Wagler, 1824) (n = 10). The composition of species found here represents a combination of Cerrado and Amazonian savanna fauna.

Small mammal distributional patterns in Northwestern Argentina

ABSTRACT Quantitative evaluations of species distributional congruence allow evaluating previously proposed biogeographic regionalization and even identify undetected areas of endemism. The geographic scenery of Northwestern Argentina offers ideal conditions for the study of distributional patterns of species since the boundaries of a diverse group of biomes converge in a relatively small region, which also includes a diverse fauna of mammals. In this paper we applied a grid-based explicit method in order to recognize Patterns of Distributional Congruence (PDCs) and Areas of Endemism (AEs), and the species (native but non-endemic and endemic, respectively) that determine them. Also, we relate these distributional patterns to traditional biogeographic divisions of the study region and with a very recent phytogeographic study and we reconsider what previously rejected as 'spurious' areas. Finally, we assessed the generality of the patterns found. The analysis resulted in 165 consensus areas, characterized by seven species of marsupials, 28 species of bats, and 63 species of rodents, which represents a large percentage of the total species (10, 41, and 73, respectively). Twenty-five percent of the species that characterize consensus areas are endemic to the study region and define six AEs in strict sense while 12 PDCs are mainly defined by widely distributed species. While detailed quantitative analyses of plant species distribution data made by other authors does not result in units that correspond to Cabrera's phytogeographic divisions at this spatial scale, analyses of animal species distribution data does. We were able to identify previously unknown meaningful faunal patterns and more accurately define those already identified. We identify PDCs and AEs that conform Eastern Andean Slopes Patterns, Western High Andes Patterns, and Merged Eastern and Western Andean Slopes Patterns, some of which are re-interpreted at the light of known patterns of the endemic vascular flora. Endemism do not declines towards the south, but do declines towards the west of the study region. Peaks of endemism are found in the eastern Andean slopes in Jujuy and Tucumán/Catamarca, and in the western Andean biomes in Tucumán/Catamarca. The principal habitat types for endemic small mammal species are the eastern humid Andean slopes. Notwithstanding, arid/semi-arid biomes and humid landscapes are represented by the same number of AEs. Rodent species define 15 of the 18 General Patterns, and only in one they have no participation at all. Clearly, at this spatial scale, non-flying mammals, particularly rodents, are biogeographically more valuable species than flying mammals (bat species).