Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation

ABSTRACTINTRODUCTION: Hydatid cysts are rarely detected in muscle tissue (0.7-0.9%), even in endemic countries. The aim of this study was to present information regarding the clinical manifestations, diagnosis, and management of muscle echinococcosis.METHODS: Twenty-two patients with hydatid cysts in the muscle were followed from January 2006 through December 2014.RESULTS: Twenty-four sites of muscle involvement were observed in the 22 patients. Fifteen (68%) of our patients were women, while seven (32%) were men. The mean age was 28.1 ± 15.4 (6-61) years. The most frequent locations were the thigh (27.2%) and the paravertebral region (13.6%). Most patients reported a painless slow-growing mass with normal overlying skin. Most (90.2%) cases were treated by surgical excision and fine-needle aspiration.CONCLUSIONS: Primary muscle hydatid cyst should be considered in the differential diagnosis in cystic masses of the muscular system without pain and localized enlargement of soft tissue, especially in endemic areas. Hydatid cyst should be investigated using serological tests and imaging modalities. If possible, total surgical excision of hydatid cyst in the muscle should be performed.

Integrative literature review of the reported uses of serological tests in leprosy management

Abstract: An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

Management of pregnancy in a University Hospital: a 6-year study

In order to evaluate the obstetric care in the Obstetric Clinic of the Gynaecology and Obstetrics Department of University of São Paulo, the authors present a survey of the management of pregnancy during the 6-year period from 1993 to 1998. The number of deliveries increased during the study by 45% over the 6 years. During this same period the number of fetal deaths was 526 (4.48%), but there was a significant decrease (p < 0.05) in the incidence of fetal death. However, there was no concomitant increase in the proportion of pregnant women with prenatal care that could explain this improvement. Incidence of premature labor also decreased considerably. The authors believe that the increment in the number of deliveries was due mainly to the increasing number of pregnant women referred to our service. The efforts made by the service towards decreasing the time of hospitalization of both newborns in the nursery and the mothers in the hospital made this possible. Despite the increasing number of deliveries, there was a significant improvement in the management of pregnancy during the period of study. This improvement may be a consequence of the standardization of a protocol of management of pregnancy based on the recent progress in scientific and technological knowledge.

Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis

OBJECTIVES: To evaluate the use of inhaled nitric oxide (NO) in the management of persistent pulmonary hypertension of the newborn. METHODS: Computerized bibliographic search on MEDLINE, CURRENT CONTENTS and LILACS covering the period from January 1990 to March 1998; review of references of all papers found on the subject. Only randomized clinical trials evaluating nitric oxide and conventional treatment were included. OUTCOMES STUDIED: death, requirement for extracorporeal membrane oxygenation (ECMO), systemic oxygenation, complications at the central nervous system and development of chronic pulmonary disease. The methodologic quality of the studies was evaluated by a quality score system, on a scale of 13 points. RESULTS: For infants without congenital diaphragmatic hernia, inhaled NO did not change mortality (typical odds ratio: 1.04; 95% CI: 0.6 to 1.8); the need for ECMO was reduced (relative risk: 0.73; 95% CI: 0.60 to 0.90), and the oxygenation was improved (PaO2 by a mean of 53.3 mm Hg; 95% CI: 44.8 to 61.4; oxygenation index by a mean of -12.2; 95% CI: -14.1 to -9.9). For infants with congenital diaphragmatic hernia, mortality, requirement for ECMO, and oxygenation were not changed. For all infants, central nervous system complications and incidence of chronic pulmonary disease did not change. CONCLUSIONS: Inhaled NO improves oxygenation and reduces requirement for ECMO only in newborns with persistent pulmonary hypertension who do not have diaphragmatic hernia. The risk of complications of the central nervous system and chronic pulmonary disease were not affected by inhaled NO.

Intestinal intussusception and occlusion caused by small bowel polyps in the Peutz-Jeghers syndrome. Management by combined intraoperative enteroscopy and resection through minimal enterostomy: case report

The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome. CASE REPORT: This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception. DISCUSSION: An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful. CONCLUSION: We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.

Laparoscopic versus open splenectomy in the management of hematologic diseases

Splenectomy is the best available treatment for severe forms of hereditary spherocytosis, idiopathic thrombocytopenic purpura, and other hematologic conditions when these prove refractory to conservative management. It has been employed for many decades with low mortality and favorable remission rates. The use of laparoscopic splenectomy in recent years has been rapidly and even enthusiastically adopted in this field. However, the exact role of laparoscopic versus open surgery for hematologic diseases is still debated. In this study of 58 adult patients, laparoscopic procedures were compared with conventional splenectomies for similar indications. METHODS: All patients were operated on within an 8-year period. Subjects underwent similar procedures under the supervision of the same surgical school and were compared regarding age, gender, body mass index, and diagnosis. Laparoscopically managed cases (Group I, n = 30) were prospectively followed according to a written protocol, whereas the same investigation was retrospectively done with regard to traditional laparotomy (Group II, n = 28). Methods included general and demographic findings, duration and technical steps of operation, blood loss, weight of spleen, need for conversion (in minimally invasive subjects), intraoperative and postoperative complications, time until realimentation, postoperative hospitalization, mortality, and late follow-up including recurrence rate. RESULTS: Idiopathic thrombocytopenic purpura was the surgical indication in over 50% of the patients in both groups, but familial spherocytosis, thalassemia, myelodysplasia, and lymphomas were also represented in this series. Laparoscopic procedures took more time to perform (P = 0.004), and postoperative hospitalization was 2 days shorter, but this difference was not statistically significant. Postoperative hematocrit and volume of blood transfusions was equivalent, although the laparoscopic cases had a somewhat lower preoperative hematocrit (NS) and displayed better recovery for this measurement (P = 0.03). More patients in Group I were able to accept oral food on the first day than subjects undergoing conventional operations (P < 0.05). Relatively few conversions were necessary during the minimally invasive surgeries (13.3%), and postoperative early and late complications as well as recurrences occurred in similar proportions. Also, the mean weight of the spleen was not statistically different between the groups, although there was a marked numerical tendency toward larger masses in conventional procedures. No spleen in Group I exceeded 2.0 kg, whereas in Group II values up to 4.0 kg occurred, and the mean weight was 50% higher in the latter group. CONCLUSIONS: 1) Minimally invasive splenectomy was essentially comparable to open surgery with regard to safety, efficacy, and late results; 2) Advantages concerning shorter postoperative hospitalization could not be shown, despite earlier food intake and a non-significant tendency toward earlier discharge; 3) This new modality should be considered an option in cases of hematologic conditions whenever the spleen is not hugely enlarged.

Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit

OBJECTIVE: To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. METHODOLOGY: Evidence-based medicine was done by a systematic review using an electronic data base (LILACS, 1982 through 2000) and (MEDLINE, 1966 through 2000). The key words used are listed and age limits (0 to 18 years) were used. RESULTS: One hundred and eighty two articles were found and after selection according to the exclusion/inclusion criteria and objectives 17 relevant papers were identified. The most common decisions found were do-not-resuscitation orders and withdrawal or withholding life support care. The justifications for these were "imminent death" and "unsatisfatory quality of life". CONCLUSION: Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient.

THE VEGETATION OF A SEASONAL VÁRZEA FOREST IN THE LOWER SOLIMÕES RIVER, BRAZILIAN AMAZONIA

The species composition of the seasonal várzea forest growing on a bank of the Ilha de Marchantaria / lower Solimões-Amazonas River, Brazil was studied in an area of slightly less than one hectare. Two biomass plots were harvested. Forty-seven arboreal species representing 46 genera in 25 families were recorded. Tree density was 1086 per hectare. Total basal area was 45 m2 ha1. Mean species density was 6.5 ± 1.98 per 100 m2. The most abundant species were Crataeva benthamii(Capparidaceae), Laetia corymbutosa(Flacourtiaceae) and Vitex cymosa(Verbenaceae). The highest basal area per species was 10.2 m2 for Pseudobombax munguba(Bombacaceae). The common species are known to be typical floristic elements of the seasonal varzea forest. Above ground dry biomass was equal to 97 and 255 t ha', respectively. Its chemical composition is characterized by comparatively high bioelement contents equal to 2.4 percent on the average. Calcium was the most important bioelement. Structure of the forest and age darings of trees allow the successional classification of the stands.

Seasonal changes of leaf Nitrogen content in trees of Amazonian floodplains

In Amazonian floodplains the trees are exposed to extreme flooding of up to 230 days a year. Waterlogging of the roots and stems affects growth and metabolic activity of the trees. An increased leaf fall in the aquatic period and annual increment rings in the wood indicate periodical growth reductions. The present study aims at documenting seasonal changes of metabolism and vitality of adult trees in the annual cycle as expressed by changes of leaf nitrogen content. Leaves of six tree species common in floodplains in Central Amazonia and typical representants of different growth strategies were collected every month between May 1994 and June 1995 in the vicinity of Manaus, Brazil. Mean leaf nitrogen content varied between 1.3% and 3.2% in the non-flooded trees. Three species showed significantly lower Ν content in the flooded period (p=0.05, 0.001, 0.001), the difference ranging 20-25% lower than in the non-flooded period. Two species showed no significant difference while Nectandra amazonum showed 32% more Ν in the flooded season (p=0.001). Leaf nitrogen content was generally high when new leaves were flushed (in the flooded period) and decreased continuously thereafter in all species. Three species showed an additional peak of nitrogen during the first month of the terrestrial phase, in leaves which had flushed earlier, indicating that flooding may disturb nitrogen uptake.

Mites (Arachnida, Acari) on Citrus sinensis L. Osbeck orange trees in the state of Amazonas, Northern Brazil

Despite the importance of citriculture in Brazil, very little is known about mite populations in citrus crops in the Northern Region. In the municipality of Manaus, 12 sprayed sweet orange orchards were surveyed every two weeks during seven months to record mite species amount, and to describe the abundance and distribution of the most important species. The size and age of the orchards varied from 3,360 to 88,080 m² and seven to 25 years, respectively. In the fourteen sampling period, leaves, twigs and fruits were collected from 12 trees, one per orchard. In total, 3,360 leaves, 672 twigs and 1,344 fruits were sampled from 168 trees. Mites were manually extracted from the fruits, and by the washing method on leaves and twigs. We identified pests with the potential to cause economic loss. Fourteen species of phytophagous and mycophagous mites from Eriophyidae, Tarsonemidae, Tenuipalpidae, and Tetranychidae were recorded. Brevipalpus phoenicis (Geijskes 1939) and Phyllocoptruta oleivora (Ashm., 1879), the two commonest phytophagous mites in other Brazilian regions were dominant, showing that local orchards are susceptible to their infestation. Eleven predatory mites were recorded, comprising 10% of the mite population, belonging to Phytoseiidae and Ascidae. Phytoseiidae was the richest family, with ten species. The results are discussed in relation to the temporal variation aspects and habitat use of the most important species. Long-term research encompassing chemical applications followed by evaluations of the mite community are necessary for a better management of the orchards, taking into consideration the seasonal phenology of key pests.

Seasonal and spatial variations in limnological conditions of a floodplain lake (lake Catalão) connected to both the Solimões and Negro Rivers, Central Amazonia

Lakes play an important role in biogeochemical, ecological and hydrological processes in the river-floodplain system. The aim of this study was to evaluate the dynamics of the limnological conditions of Catalão Lake, an Amazon floodplain lake. Thus, some of the main limnological environment variables (O2, temperature, pH, nutrient, electrical conductivity) of the Catalão Lake were analyzed under temporal and spacial scales. The study was conducted between November/2004 and August/2005. Sampling excursion were carried out every three months; one excursion for each of the four different hydrological periods (low water, rising water, high water and falling water). Sampling points were chosen so that it could be obtained a gradient of the distance from Negro River. Limnological profiles in Catalão Lake showed generally acidic to slightly alcaline water, with low levels of dissolved oxygen and low concentrations of soluble reactive phosphorous. The Negro River seems to exert the main influence during the rising water period, while the Solimões River is the principal controlling river during peak water. The Principal Component Analysis (PCA) grouped the seasonal collections by hydrological period, showing the formation of a north-south spatial gradient within the lake in relation to the limnological variables. Multivariate dispersion analysis based on distance-to-centroid method demonstrated an increase in similarity over the course of the hydrological cycle, as the lake was inundated in response to the flood pulse of the main river channels. However, the largest spatial homogeneity in the lake was observed in the epilimnion layer, during the falling water period. The daily analysis of variation indicated an oligomitic pattern during the years in which the lake was permanently connected to the Negro River. Although Catalão Lake receives large quantities of both black water from the Negro River and sediment-filled water from the Solimões River, the physical and chemical characteristics of the lake are more similar to those of the Solimões (várzea lake) than the Negro (blackwater lake).

Seasonal effects and antifungal activity from bark chemical constituents of Sterculia apetala (Malvaceae) at Pantanal of Miranda, Mato Grosso do Sul, Brazil

In the Southern Pantanal, the hyacinth macaw (Anodorhynchus hyacinthinus), an endangered species, often chooses the manduvi tree (Sterculia apetala) as a nesting site, because of its physical properties. In addition, the chemical composition of the wood may also contribute to a nesting selection by the hyacinth macaws. The objective of this study was to determine the main chemical components of S. apetala bark for two seasons, and evaluate its fungicidal potential. Bark samples from S. apetala trees with and without nests of A. hyacinthinus were collected in January (wet season) and August (dry season) of 2012. The inhibition of mycelium growth (MGI) from tree samples with and without nests were assessed using a phytochemical analysis to evaluate their antifungal activity against Trichoderma sp. Phytochemical analysis confirmed the presence of phenolic compounds and flavonoids. In both seasons, samples obtained from nested trees had higher content of total phenols than those collected from non-nested trees. The average content of total flavonoids was higher in January for samples with nest and in August for samples without nest. All selected samples showed antifungal activity, and those with nest collected in August (peak of hyacinth macaw breeding) resulted in an MGI of 51.3%. Therefore, this percentage, related to the content of flavonoids and the presence of coumarins, may influence the reproductive success of hyacinth macaws and other species of birds, in this region. This is the first chemical study report with the stem bark of S. apetala.

The seasonal diet of Aequidens tetramerus (Cichlidae) in a small forest stream in the Machado River basin, Rondônia, Brazil

Trophic relationships in fish communities are affected by the availability of resources, which in turn is affected by spatial and temporal variations throughout the year. The aims of this study were to characterize the diet of A. tetramerus in a streamlet in the north of Brazil and compare its composition in different hydrological seasons (wet and dry seasons). Collections were performed every two months from October 2011 to September 2012 with the aid of seine nets, hand net and fishing traps in the streamlet located in the Machado River drainage basin in the Rondônia state. Most of the specimens collected were quite small (< 40 mm) and had empty stomachs. Our results showed that A. tetramerus feeds on a wide variety of items of plant origin, such as algae, seeds and leaves, as well as items of animal origin, including bryozoans, crustaceans, fish scales, terrestrial insects and detritus. The data also indicated higher consumption of aquatic insects than other food items, suggesting a primarily insect-based diet. Items of plant and allochthonous origin were consumed more in the wet season than in the dry season, but there were no seasonal differences in the consumption of animal and autochthonous items.