Requiem for Nigro or is anal squamous carcinoma still a surgical problem: abdominoperineal excision rather than a defunctioning stoma?

Background: Combined multimodal treatment (CMT) is the preferred treatment for anal squamous carcinoma with radical surgery reserved for treatment failure. Some patients require a defunctioning stoma prior to CMT. Successful closure of such a stoma is unlikely. Abdominoperineal excision (APE) may be suitable as primary treatment in these patients.Objectives: To evaluate organ preservation in the treatment of anal squamous cancer and the closure rate of pre-treatment, temporary diverting colostomy, thereby assessing whether APE could be offered as primary treatment in those requiring a pre-treatment colostomy.Methods: A retrospective review of all patients with anal squamous carcinoma was undertaken. Patients who required defunctioning colostomies prior to CMT were analysed for potential resectability of tumour prior to CMT and rate of permanent stoma.Results: One hundred and twenty-five patients were included of which 58 were males. The mean age was 56 years. 107 were treated with curative intent. Six received primary APE and 12 salvage APE. Thirty (22 males) required pre-treatment diverting colostomies. Three (10%) stomas were successfully reversed. Forty-eight (38%) of the 125 completed treatment with a permanent colostomy. Six patients who needed a stoma prior to CMT were deemed resectable.Conclusion: Organ preservation was not possible in about a third of patients. Defunctioning stomas prior to CMT were likely to be permanent. We propose that APE could be considered as an alternative in selective cases where the tumour is resectable with low morbidity and a stoma is indicated

Exotic species of zooplankton in the Upper Paraná River floodplain, Daphnia lumholtzi Sars, 1885 (Crustacea: Branchiopoda) / Espécie exótica de zooplâncton na planície de inundação do Alto Rio Paraná, Daphnia lumholtzi Sars, 1885 (Crustacea: Branchiopoda)

The integrity of aquatic ecosystems is being challenged worldwide by invading species, which has been one of the frequent causes of biodiversity loss. The invader may cause extinctions of vulnerable native species through predation, grazing, competition and habitat alteration. Daphnia lumholtzi G. O. Sars, 1885, a native cladoceran from Australia, Southwestern Asia and North Africa, has recently been found in the Neotropical region. The D. lumholtzi records from the Upper Paraná River floodplain were restricted to the Pombas floodplain lake (22º 47' 55.92" S and 53º 21' 32.58" W) and Pau Véio Backwater (22º 44' 50.76" S and 53º 15' 11.16" W), in 2003 and 2008, respectively. This species can be distinguished from the other Daphnia species registered in Brazil by the conspicuous pointed fornix, the sizes of the tail spine and helmet, and a carapace ventral margin with strong spines. The high temperatures in the tropical region, as well as the increase in water transparency and the decrease in nutrient concentration observed in the environments of the Upper Paraná River floodplain due to the upstream retention by dams, may favor the development of D. lumholtzi populations. The development of populations of D. lumholtzi in natural environments of the Upper Paraná River floodplain may suggest that this species is establishing in the Neotropical region.

A integridade dos ecossistemas aquáticos está sendo desafiada no mundo inteiro por espécies invasoras, as quais tem sido uma das causas freqüentes de perda de biodiversidade. Um invasor pode causar extinções de espécies nativas vulneráveis através de predação, herbivoría, competição e alteração de habitat. Daphnia lumholtzi G. O. Sars, 1885, cladócero nativo da Austrália, sudeste da Ásia e norte da África, recentemente tem sido registrado na região neotropoical. Os registros de D. lumholtzi na planície de inundação do Alto Rio Paraná foram restritos a lagoa das Pombas (22º 47' 55.92" S e 53º 21' 32.58" O) e Ressaco do Pau Véio (22º 44' 50.76" S e 53º 15' 11.16" O), em 2003 e 2008, respectivamente. Esta espécie pode ser diferenciada das demais espécies de Daphnia encontradas no Brasil pelos conspícuos fórnices pontiagudos, tamanho dos espinhos caudal e elmo, e margem ventral com espinhos fortes. As elevadas temperaturas na região tropical, o aumento da transparência da água e a redução das concentrações de nutrientes nos ambientes da planície de inundação do alto rio Paraná, devido aos represamentos a montante, podem estar favorecendo o desenvolvimento de populações de D. lumholtzi. O desenvolvimento de populações de D. lumholtzi em ambientes naturais da planície de inundação do alto rio Paraná pode representar o estabelecimento desta espécie na região neotropical.

Cladocera fauna composition in a river-lagoon system of the upper Paraná River floodplain, with a new record for Brazil

Cladocera communities were studied in lotic and lentic environments of the Upper Paraná River floodplain, State of Mato Grosso do Sul, Brazil. A total of 63 species of Cladocera were identified in 108 samples. Of these, 24 species are considered new records for that floodplain, and one is a new record for Brazil. Chydoridae was the most representative family with 19 genera and 39 species

Anatomia cirúrgica do acesso transoral / Surgical anatomy of the transoral approach

O tratamento cirúrgico das lesoes localizadas no clivus, junçao craniocervical e coluna cervical alta pode se acompanhar de morbidade e mortalidade importantes. O acesso transoral é uma via direta e adequada para essa regiao. Para estudar as relaçoes anatômicas desse acesso, realizou-se um estudo em 15 hemicabeças de cadáveres fixados em formalina a 20 por cento. As principais distâncias envolvendo o acesso transoral foram medidas para determinar seus limites e suas vantagens.

Middle cerebral artery revscularization: anatomical studies and considerations on the anastomosis site

In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.