Current management of patients with cutaneous melanoma with a positive sentinel lymph node / Tratamiento actual de pacientes con melanoma cutáneo y ganglio centinela positivo

Abstract Introduction : Immediate completion lymph node dissection (CLND) performed in patients with a positive sentinel lymph node biopsy (SLNB) cutaneous melanoma is not associated with improved melanoma specific survival versus active surveillance (AS) using nodal ul trasound. Clinical practice experience and outcomes of AS and adjuvant therapy is now starting to be published in literature. Methods : Retrospective analysis of patients with a positive-SLNB between June/2017-February/2022. Impact of management on any-site recurrence free survival (RFS), isolated nodal recurrence (INR), distant metasta sis-free survival (DMFS) and melanoma-specific survival (MSS) was evaluated. Results : From 126 SLNB, 31 (24.6%) were positive: 24 received AS and 7 CLND. Twenty-one (68%) received ad juvant therapy (AS, 67% and CLND, 71%). With a median follow-up of 18 months, 10 patients developed recur rent disease with an estimated 2-yr RFS of 73% (CI95%, 0.55-0.86) (30% in AS group vs. 43% in dissection group; P = 0.65). Four died of melanoma with an estimated 2-yr MSS of 82% (CI 95%, 0.63-0.92) and no differences between AS and CLND groups (P = 0.21). Estimated 2-yr DMFS of the whole cohort was 76% (CI 95%, 0.57-0.88) with no differences between groups (P = 0.33). Conclusion : Active surveillance strategy has been adopted for most positive-SLNB cutaneous melanoma patients. Adjuvant therapy without immediate CLND was delivered in nearly 70% of patients. Our results align with outcomes of randomized control trials and previous real-world data.

Resumen Introducción : La linfadenectomía inmediata (LI) re alizada en pacientes con biopsia de ganglio centinela (BGC) positivo por melanoma cutáneo no está asociada a mejoría en la supervivencia libre de enfermedad vs. vigilancia activa (VA). Resultados oncológicos y experi encia en la práctica clínica con dicha conducta asociados a tratamiento adyuvante comienzan a ser publicados en la literatura. Métodos : Análisis retrospectivo incluyendo paci entes con BGC-positiva por melanoma cutáneo entre junio/2017-febrero/2022. Se evaluó impacto del manejo en: supervivencia libre de recurrencia (SLR), recurren cia ganglionar aislada (RGA), supervivencia libre de metástasis a distancia (SLMD) y supervivencia libre de enfermedad (SLE). Resultados : De 126 pacientes, 31 (24.6%) fueron positi vos: en 24 se realizó VA y en 7 LI. Veintiún pacientes (68%) recibieron tratamiento adyuvante (VA, 67% y LI, 71%). Con una media de seguimiento de 18 meses, 10 pacientes presentaron recurrencia de la enfermedad con una SLR estimada a 2 años del 73% (CI95%, 0.55-0.86) (30% en VA vs. 43% en LI; P = 0.65). Cuatro murieron de melanoma con una SLE a 2 años del 82% (CI 95%, 0.63-0.92); sin diferencia entre ambos grupos (P = 0.21). La SLMD a 2 años de toda la cohorte fue de 76% (CI 95%, 0.57-0.88; P = 0.33). Conclusión : La vigilancia activa se ha adoptado como conducta para la mayoría de los pacientes con BGC-positivo. El tratamiento adyuvante sin linfadenectomía inmediata se realizó en cerca del 70% de nuestra serie. Los resultados de nuestra serie son similares a los re portados en la literatura.

Outcomes after laparoscopic adrenalectomy for unilateral primary aldosteronism / Resultados luego de adrenalectomía laparoscópica en hiperaldosteronismo primario unilateral

Abstract Unilateral primary aldosteronism (PA) is the most common surgically correctable cause of hypertension. Determination of success after laparoscopic adrenalectomy (LA) is limited by the lack of standardized criteria. We sought to evaluate the surgical recurrence and functional outcomes of LA in patients with Conn's syndrome applying the primary aldosteronism surgical outcome (PASO) Criteria. Descriptive obser vational analysis of patients treated with LA due to confirmed u nilateral Conn's syndrome between May 2007 and August 2020: Twenty patients were included in the cohort; 16 patients had TLA and other four PLA [58% male, median age 47 (IQR: 44-59.5) years and median follow-up of 64 (IQR: 2-156) ] months. Median tumor size was 1.2 (0.8-1.8) cm. No conversions to open surgery were recorded and the overall morbidity of the series was 1/20. No surgical or biochemical recurrence was observed. Five patients were excluded from the analysis of functional results due to lack of follow-up. According to the PASO criteria, complete, partial, and no success were observed in 8/15, 6/15, and 1/15, respectively. The surgical treatment of the disease is supported by the literature, and we were able to reproduce the results of other series. The use of standardized and reproducible criteria to assess its functional results would be essential for a more complete and integrated evaluation of adrenal surgery.

Resumen El hiperaldosteronismo primario es la causa más frecuente de hipertensión secundaria pasible de tratamiento quirúrgico. La determinación del éxito de la adrenalectomía laparoscópica (AL), actualmente, está limitada por la falta de criterios estandarizados. Buscamos evaluar la tasa de recurrencia quirúrgica y los resultados funcionales de la AL en pacientes con Síndrome de Conn aplicando los criterios PASO (primary aldosteronism surgical outcome). Análisis descriptivo y observacional de pacientes tratados con AL en contexto de síndrome de Conn unilateral confirmado, entre Mayo-2007 y Agosto-2020. Se incluyeron 20 pacientes en el estudio; 16 pacientes tratados mediante AL total y 4 con AL parcial (55% hombres, edad mediana de 47 (IQR: 44-59.5) años y mediana de seguimiento 64 (IQR: 2-156) meses. La mediana de tamaño tumoral fue de 1.2 (0.8-1.8) cm. No se registraron conversiones a cirugía abierta y la morbilidad global de la serie: 1/20. No se observó recurrencia quirúrgica o bioquímica. Se excluyeron 5 pacientes en el análisis de resultados funcionales por falta de seguimiento. Según los criterios PASO, se observó un éxito completo, parcial y ausente en 8/15, 6/15 y 1/15, respectivamente. El tratamiento quirúrgico de la enfermedad es avalado por la literatura y pudimos reproducir los resultados de otras series. El uso estandarizado y reproducible de criterios para valorar sus resul tados funcionales sería fundamental para una evaluación más completa e integrada de la cirugía suprarrenal.

PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review / 신경중재치료의학

The PulseRider is a neuroendovascular adjunct for wide-necked intracranial aneurysms. The decreased metal burden of the PulseRider theoretically reduces artifact on radiologic imaging. However, we report here on a case of a patient who underwent PulseRider-assisted stent-coiling of a basilar tip aneurysm. He returned 19 months later for intermittent diplopia and darkening of vision but was neurologically intact on exam. Both contrast-enhanced and time-of-flight magnetic resonance angiography (MRA) demonstrated absence of signal in the basilar artery in the proximal anchors of the PulseRider. Given his lack of reproducible symptoms and high functional status, it is presumed that the imaging reflected artifact and not thrombosis/stenosis. Although the PulseRider is a useful treatment option for wide-necked intracranial aneurysms, the clinician should be aware that even contrast-enhanced MRA can produce artifact that resembles thrombosis/stenosis. Non-angiogram radiologic imaging modalities may be appropriate for evaluation for residual aneurysm but not patency of the parent artery.

A compilation of host plants and their gall-inducing insects for the Caatinga Biome / Uma compilação de plantas hospedeiras e seus insetos galhadores para o bioma Caatinga

Caatinga is a seasonally dry tropical forest, one of the richest in plant species. Unfortunately, many groups of herbivorous insects associated with these plants are poorly known. This study aimed to investigate the diversity of gall-inducing insects (GII) and host plants (HP) in the Caatinga. For this, we compiled the information available in the literature of inventories on GII and their HP communities, and the described gall midge species. We found 100 species, 72 genera, and 32 families of HP hosting a total of 156 morphospecies of GII and 12 species of described cecidomyiids. Plant species with only one GII species represented 74% of hosts, but in super HP (i.e., HP with a high number of GII), despite the small number of HP species, there were many GII species. Fabaceae was also the most specious family, with 30% of HP species and 40% of GII. Furthermore, our results showed a low number of species of HP and GII for the Brazilian Caatinga, that we discussed this pattern with the following arguments, first, it is likely that the number of galling insect inventories for the Caatinga is under-sampled, second the Caatinga has a relatively smaller number of plant species when compared to other biomes, and finally, we argue that the Caatinga is a seasonally dry tropical forest where the deciduousness represents a relevant factor in the colonization and performance rates of GII.

A Caatinga é uma floresta tropical sazonalmente seca, uma das mais ricas em espécies vegetais. Infelizmente, muitos grupos de insetos herbívoros associados a essas plantas são pouco conhecidos. Este estudo teve como objetivo investigar a diversidade de insetos galhadores (IG) e plantas hospedeiras (PH) na Caatinga. Para isso, nós compilamos as informações disponíveis na literatura de inventários sobre a comunidade de IG e suas PH, e as espécies descritas de cecidomiídeos. Nós encontramos 100 espécies, 72 gêneros e 32 famílias de PH abrigando um total de 156 morfoespécies de IG e 12 espécies descritas de cecidomiídeos. Espécies de plantas com apenas uma espécie de IG representaram 74% das hospedeiras, mas para as super PH (ou seja, PH com alto número de IG), apesar do pequeno número de espécies de PH, havia muitas espécies de IG. Fabaceae foi a família mais rica, com 30% das espécies de PH e 40% dos IG. Além disso, nossos resultados mostraram um baixo número de espécies de PH e IG para a Caatinga brasileira, e discutimos esse padrão com os seguintes argumentos, primeiro, é provável que o número de inventários de insetos galhadores para a Caatinga seja subamostrado, segundo a Caatinga possui um número relativamente menor de espécies vegetais quando comparada a outros biomas e, por fim, argumentamos que a Caatinga é uma floresta tropical sazonalmente seca onde a deciduidade representa um fator relevante para as taxas de colonização e desempenho dos IG.

Diagnóstico y tratamiento de la etapa aguda del accidente cerebrovascular isquémico: Guía de práctica clínica del Seguro Social del Perú (EsSalud) / Diagnosis and therapy for the acute stage of ischemic cerebrovascular accident: A clinical practice guideline from Peruvian Social Security (EsSalud)

RESUMEN Objetivo: proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Medline y Cochrane Controlled Register of Trials durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de diagnóstico y tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2019. Resultados: la presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, tratamiento, soporte y rehabilitación. En base a estas preguntas se formularon 28 recomendaciones (8 fuertes y 20 condicionales), 38 puntos de buena práctica clínica, 1 nota de implementación y 2 flujogramas. Conclusión: el presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud.

ABSTRACT Objective: to provide evidence based clinical recommendations for the diagnosis and therapy of the acute stage of ischemic cerebrovascular accident in EsSalud. Materials and methods : a group for producing the guideline was conveyed, including specialized physicians and methodologists. The group prepared 8 clinical questions to be answered by the guideline. Systematic searches of previous reviews were performed, and - when it was deemed necessary - primary studies in Medline and the Cochrane Controlled Registry of Trials for 2018 were reviewed. Evidence was selected aiming to respond each one of the proposed clinical questions. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work sessions, the group used GRADE methodology for reviewing the evidence and generated recommendations, good clinical practice items, and designed flow charts for both diagnosis and therapy. Finally, the guide was approved with the decree N° 128-IETSI-ESSALUD-2019. Results : this clinical practice guideline focused in 8 clinical questions, which were divided into four topics: screening, diagnosis, therapy, support and rehabilitation. On the basis of these questions, 28 recommendations were formulated (8 strong and 20 conditional), 38 items for good clinical practice, 1 implementation note, and 2 flow charts. Conclusion : this paper summarizes both evidence based methodology and conclusions from a new clinical practice guide for diagnosis and therapy of the acute stage of a cerebrovascular accident in EsSalud.

Guía de práctica clínico-quirúrgica para hemorragia digestiva baja / Clinical practice guide in lower gastrointestinal bleeding

El objetivo de esta guía clínico-quirúrgica es homogeneizar conceptos y conductas para el manejo de la hemorragia digestiva baja (HDB), con el fin de protocolizar y unificar el tratamiento multidisciplinario de dicha patología. Durante el manejo inicial del paciente con HDB, resulta prioritario determinar la estabilidad hemodinámica. Cuando el paciente se presenta hemodinámicamente estable, la videocolonoscopia (VCC) es el método diagnóstico de elección, la cual debe realizarse con preparación colónica y dentro de las 48 horas, mientras que si se trata de un paciente inestable que no responde a la reanimación debe realizarse, de ser posible, angiotomografía para localizar el sitio de sangrado y posteriormente angiografía. Si las condiciones no lo permiten, se procede directamente a la cirugía de urgencia. Si se logra reanimar al paciente, el método diagnóstico de elección es la videoendoscopia digestiva alta (VEDA). Si la VEDA es negativa y el paciente permanece estable, se prosigue con VCC. Por el contrario, si continúa sangrando, el paso siguiente es la angio-TC. En caso de localizar el sitio de sangrado, se realiza angiografía terapéutica. Si falla o la angio-TC es negativa, tiene indicación de cirugía. Esta guía fue consensuada a partir de la bibliografía, guías internacionales y la experiencia de los Servicios de Cirugía General, Coloproctología, Gastroenterología, Diagnóstico por Imágenes y Hemodinamia.(AU)

Off-Label Application of Pipeline Embolization Device for Intracranial Aneurysms / 신경중재치료의학

PURPOSE: The Pipeline embolization device (PED) is approved in the USA for treating giant and large aneurysms arising from the petrous to superior hypophyseal segments of the internal carotid artery in patients older than 21 years of age. This study investigates off-label PED results in a large cohort. MATERIALS AND METHODS: Retrospective, single-center review of all patients who had off-label PED surgery. RESULTS: Sixty-two aneurysms (48 patients) underwent off-label PED treatment from 2012–2017. There were 44 females and four males (age 21 to 75 years; mean/median, 54.3/55.0 years). The most common presenting symptom was headache (47/62, 75.8%). All aneurysms were in the anterior circulation. Aneurysm size ranged from 1.4 to 25.0 mm (mean/median, 7.6/6.9 mm). Fifty-two aneurysms had post-operative imaging with total/near-complete occlusion of 84.6% (44/52). Aneurysm-based operative near-term complication rate was 9.7% while there were no permanent complications. For aneurysms and headache, 86.7% improved/resolved after embo-surgery, and were four times more likely to have a better clinical outcome (resolved or improved symptoms) after surgery (odds ratio [OR], 4.333; P=0.0325). Left-sided aneurysms had a higher occlusion rate (OR, 20; P=0.0073). Hypertension (OR, 4.2; P=0.0332) and smoking (OR, 7; P=0.0155) were more prone towards aneurysm occlusion. Patients without a family history were 14 times more likely to have favorable imaging outcome (P=0.0405). There is no difference of occlusion rates between untreated and previously treated aneurysms (P=0.6894). Overall, occlusion rate decreased by 14% with an increase of aneurysm size by 1 mm (P=0.0283). CONCLUSION: For anterior circulation aneurysms, the off-label application of PED is as effective and safe as reported for on-label intracranial aneurysms.

Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique / 신경중재치료의학

Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

Bronchoalveolar lavage as a tool for evaluation of cellular alteration during Aelurostrongylus abstrusus infection in cats / Lavado broncoalveolar como ferramenta para avaliação de alterações celulares durante a infecção por Aelurostrongylus abstrusus em gatos

Bronchoalveolar lavage (BAL) is a procedure that retrieves cells and other elements from the lungs for evaluation, which helps in the diagnosis of pulmonary diseases. The aim of this study was to perform this procedure for cellular analysis of BAL fluid alterations during experimental infection with Aelurostrongylus abstrusus in cats. Fourteen cats were individually inoculated with 800 third stage larvae of A. abstrusus and five non-infected cats lined as a control group. The BAL procedure was performed through the use of an endotracheal tube on the nineteen cats with a mean age of 18 months, on 0, 30, 60, 90, 120, 180 and 270 days after infection. Absolute cell counts in the infected cats revealed that alveolar macrophages and eosinophils were the predominant cells following infection. This study shows that the technique allows us to retrieve cells and first stage larvae what provides information about the inflammatory process caused by aelurostrongylosis.

O lavado broncoalveolar (LBA) é um procedimento que permite a recuperação de células e outros elementos pulmonares para avaliação, auxiliando no diagnóstico de doenças pulmonares. O objetivo do presente trabalho foi realizar este procedimento para avaliação das células presentes no fluido broncoalveolar na infecção experimental por Aelurostrongylus abstrusus em gatos. Quatorze animais foram individualmente inoculados com 800 larvas de terceiro estádio de A. abstrusus, enquanto cinco animais não infectados foram mantidos como grupo controle. O LBA foi realizado com uso de um tubo endotraqueal em todos os 19 animais com média de idade de 18 meses, nos dias nos dias 0, 30, 60, 90, 120, 180 e 270 após infecção. A contagem absoluta de células dos animais infectados revelou que macrófagos alveolares e eosinófilos constituíram os tipos celulares predominantes durante todo o período de infecção. Os resultados deste trabalho demonstram que a técnica permite recuperar células e larvas de primeiro estádio de A. abstrusus, fornecendo informações importantes sobre o processo inflamatório causado na aelurostrongilose.

Neuroform-EZ Stent Modification for Facilitated Delivery during Intracranial Aneurysm Embosurgery / 신경중재치료의학

The Neuroform EZ Stent System is a fourth generation intracranial aneurysm stent that utilizes an integrated navigation guidewire. While designed to facilitate stent delivery, the guidewire can rarely impede proper positioning of the stent. In this technical case report, severing the guidewire from the stent delivery system with surgical scissors was required for successful stent implantation.

Size, age and composition: characteristics of plant taxa as diversity predictors of gall-midges (Diptera: Cecidomyiidae)

Many hypotheses have been proposed to explain the diversity of gall-midge insects (Diptera: Cecidomyiidae), some of them taking into account plant diversity. This study aims to test the importance of size, age and composition of host plant taxa in the diversity of Cecidomyiidae. For this we used inventories data on the diversity of galling and host plants in Brazil. We found that Asterales, Myrtales and Malpighiales, were the most important orders, with 34, 33 and 25, gall morphotypes, respectively. The most representative host families were Asteraceae (34 morphotypes), Myrtaceae (23) and Fabaceae (22). In general, the order size and the plant family were good predictors of the galling diversity, but not the taxon age. The most diverse host genera for gall-midges were Mikania, Eugenia and Styrax, with 15, 13 and nine galler species, respectively. The size of plant genera showed no significant relationship with the richness of Cecidomyiidae, contrary to the prediction of the plant taxon size hypothesis. The plant genera with the greatest diversity of galling insects are not necessarily those with the greatest number of species. These results indicate that some plant taxa have a high intrinsic richness of galling insects, suggesting that the plant species composition may be equally or more important for the diversity of gall-midges than the size or age of the host taxon. Rev. Biol. Trop. 59 (4): 1599- 1607. Epub 2011 December 01.

Muchas hipótesis se han propuesto para explicar la diversidad de dipteros de la familia Cecidomyiidae, algunos de ellos teniendo en cuenta la diversidad de las plantas. Este estudio tiene como objetivo probar la importancia del tamaño, la edad y la composición de las plantas en la diversidad de Cecidomyiidae, a través de los inventarios de las agallas y las plantas hospederas, en Brasil. Asterales, Malpighiales y Myrtales fueron los órdenes más importantes, con 34, 33 y 25 tipos de agallas, respectivamente. Las familias más importantes fueron Asteraceae (34 morfotipos), Myrtaceae (23) y Fabaceae (22). En general, el tamaño de los órdenes y las familias de las plantas es un buen predictor de la diversidad de insectos de agallas, pero no de la edad de la taxon. Los géneros más diversos fueron Mikania, Eugenia y Styrax, con 15, 13 y nueve especies con agallas, respectivamente. El tamaño de los géneros no mostró relación significativa con la riqueza de Cecidomyiidae, lo que contradice la hipótesis del tamaño de los táxones de plantas. Los géneros de plantas más diversos en insectos inductores de agallas no son necesariamente los que tienen el mayor número de especies. Estos resultados indican que algunos táxones de plantas tienen una alta riqueza intrínseca de insectos agalleros, lo que sugiere que la composición de especies de plantas pueden ser igualmente o más importante para la diversidad de los cecidomyiideos agalleros que el tamaño o la edad del taxón.

Effect of gossypol on survival and reproduction of the zoophytophagous stinkbug Podisus nigrispinus (Dallas)

Effect of gossypol on survival and reproduction of the zoophytophagous stinkbug Podisus nigrispinus (Dallas). Gossypol is a sesquiterpene aldehyde found in cotton plants conferring resistance against herbivory. Although the effect of this sesquiterpenoid on insect pests of cotton is known, the interaction of this compound with zoophytophagous predators such as Podisus nigrispinus (Dallas) (Hemiptera, Pentatomidae) has not been studied so far. Thus, the objective of this study was to evaluate the effect of the purified gossypol on nymphs and adults of P. nigrispinus. Nymphs and adults of this predator were fed on Tenebrio molitor pupae and supplemented with solutions of gossypol at concentrations of 0.00, 0.05, 0.10, and 0.20 percent (w/v) during the nymphal and adult stages or, only during the adult stage of P. nigrispinus. The nymphal stage of the predator was, on average, two days longer when suplemmented with gossypol. Emerged adults had lower fecundity and egg hatching, especially at the highest gossypol concentration (0.20 percent) ingested during the nymphal and adult stages. However, this predator was not affected when it ingested the compound only during the adult stage. P. nigrispinus can have delayed nymphal development and lower reproductive performance when ingesting the gossypol during the nymphal and adult stages, but only at higher concentrations of gossypol than that produced by cotton plants.

Efeito do gossipol na sobrevivência e reprodução do percevejo zoofitófago Podisus nigrispinus (Dallas). O gossipol é um aldeído sesquiterpeno produzido pelo algodoeiro que confere resistência contra a herbivoria. A interação deste sesquiterpeno com predadores zoofitófagos, como Podisus nigrispinus (Dallas) (Hemiptera, Pentatomidae), é inexistente apesar do reconhecido efeito do gossipol sobre insetos pragas do algodoeiro. Assim, este estudo avaliou o efeito do extrato de gossipol sobre ninfas e adultos de P. nigrispinus. O predador foi alimentado com pupas de Tenebrio molitor L. (Coleoptera, Tenebrionidae) e suplementado com soluções do gossipol nas concentrações 0, 0,05, 0,10 e 0,20 por cento (peso/volume) durante os estágios ninfal e adulto e somente durante o estágio adulto. A duração do estágio ninfal do predador foi em média dois dias mais longo quando suplementado com gossipol. Adultos oriundos de ninfas suplementadas com gossipol apresentaram menor fecundidade e viabilidade dos ovos, em especial na maior concentração (0,20 por cento). Contudo, adultos não foram afetados quando suplementados com gossipol somente durante este estágio. Os resultados demonstram que a ingestão prolongada do gossipol ocasiona efeito no desenvolvimento e reprodução do predador P. nigrispinus, porém somente em concentração superior àquela produzida naturalmente pela planta de algodão.

Attraction of Chagas disease vectors (Triatominae) to artificial light sources in the canopy of primary Amazon rainforest

Adult triatomines occasionally fly into artificially lit premises in Amazonia. This can result in Trypanosoma cruzi transmission to humans either by direct contact or via foodstuff contamination, but the frequency of such behaviour has not been quantified. To address this issue, a light-trap was set 45 m above ground in primary rainforest near Manaus, state of Amazonas, Brazil and operated monthly for three consecutive nights over the course of one year (432 trap-hours). The most commonly caught reduviids were triatomines, including 38 Panstrongylus geniculatus, nine Panstrongylus lignarius, three Panstrongylus rufotuberculatus, five Rhodnius robustus, two Rhodnius pictipes, one Rhodnius amazonicus and 17 Eratyrus mucronatus. Males were collected more frequently than females. The only month without any catches was May. Attraction of most of the known local T. cruzi vectors to artificial light sources is common and year-round in the Amazon rainforest, implying that they may often invade premises built near forest edges and thus become involved in disease transmission. Consequently, effective Chagas disease prevention in Amazonia will require integrating entomological surveillance with the currently used epidemiological surveillance.

First record of molluscs naturally infected with Angiostrongylus cantonensis (Chen, 1935) (Nematoda: Metastrongylidae) in Brazil

Seeking the identification of Angiostrongylus cantonensis as a potential etiological agent of three clinical cases of eosinophilic meningitis, mollusc specimens were collected in the state of Espírito Santo, Brazil. The snails were identified as Sarasinula marginata (45 specimens), Subulina octona (157), Achatina fulica (45) and Bradybaena similaris (23). Larvae obtained were submitted to polymerase chain reaction and restriction fragment length polymorphism diagnosis. Their genetic profile were corresponded to A. cantonensis. Rattus norvegicus experimentally infected with third-stage larvae, developed menigoencephalitis, and parasites became sexually mature in the lungs. Additionally, larvae obtained from A. fulica snails, from São Vicente, state of São Paulo, also showed genetic profiles of this nematode. This is the first record of Brazilian molluscs infected with this nematode species.

Sexual behavior of the navel OrangeWorm, Amyelois transitella (Walker) (Lepidoptera: Pyralidae)

To get a better understanding of the mating behavior of the navel orangeworm, Amyelois transitella (Walker), we developed a robust laboratory colony derived from larvae collected in Bakersfield, California and fed on dried, roasted pistachio. In the lab at 25°C, most of the mating activity was observed during the last hour of the scotophase and for the first 30 min of the photophase. Female calling was characterized by the abdomen being protruded between the wings with the distal segments perpendicular to the body and exposing a pheromone gland, as well as by continuous antennation. Males approached calling females from a short distance by displaying wing fanning and antennation. When a male antennated on a calling female's abdomen, she either accepted the male and lowered the abdomen, or walked away. The accepted male made a final approach parallel to the female's body, but after coupling he rotated 180° with male and female remaining in a linear, abdomen-to-abdomen position for over 3 h in average. In a possible strategy to maximize the chances of mating, the sex ratio was significantly skewed towards males in the first two days of emergence. Almost 80 percent of mating took place in the first two days after adult emergence, with females mating only once. About 55 percent of males mated only once and approximately 40 percent of the observed males mated twice and 5 percent tree times.

Com o objetivo de se estudar o comportamento sexual de Amyelois transitella (Walker), desenvolveu-se uma metodologia de criação da mariposa em condições de laboratório, utilizando-se como substrato alimentar pistaches secos e torrados. A criação foi desenvolvida a partir de lagartas coletadas em Bakersfield, Califórnia. A atividade de acasalamento foi observada principalmente durante a última hora da escotofase e os primeiros 30 min. da fotofase, em laboratório mantido a 25°C. O comportamento de chamamento das fêmeas foi caracterizado pela projeção do abdome entre as asas, com os segmentos distais mantidos perpendicularmente ao corpo, pela exposição da glândula produtora de feromônio e pela contínua antenação. Os machos aproximaram-se das fêmeas "chamando" a uma curta distância, batendo fortemente as asas e movimentando as antenas. Após o macho tocar o abdome da fêmea com a antena, esta o aceita abaixando a ponta do abdome, ou não o aceita caminhando em direção oposta a ele. O macho que foi aceito pela fêmea aproxima-se, permanecendo paralelamente ao corpo dela e, nesta posição, introduz o edeago na porção final do abdome e rotaciona o corpo 180°, permanecendo em sentido linear e oposto à fêmea por mais de 3h em média. Os machos emergem antes das fêmeas, provavelmente como estratégia para aumentar as chances de acasalamento. Cerca de 80 por cento dos acasalamentos ocorreram nos dois primeiros dias de vida. As fêmeas acasalaram uma única vez, entretanto, 55 por cento dos machos acasalaram somente uma vez, 40 por cento duas vezes e 5 por cento três vezes.

Towards the identification and synthesis of the sex pheromone of the citrus leafminer, Phyllocnistis citrella Stainton ( Lepidoptera: Gracillariidae )

O objetivo desta pesquisa foi caracterizar o comportamento sexual do minador-dos-citros, Phyllocnistis citrella Stainton, como suporte para o isolamento, identificação e síntese do seu feromônio sexual. O acasalamento de P. citrella ocorre no intervalo entre 1h antes do início da fotofase e 1h após o término da escotofase, entre adultos de um e dois dias de idade. O comportamento de corte e cópula foi descrito para essa espécie, sendo a duração média da cópula de 49,6 min. Estudos conduzidos em olfatômetro tipo Y demonstraram que os machos foram fortemente atraídos pelas fêmeas virgens bem como pelo extrato natural de glândulas de feromônio sexual das fêmeas.

Hinf-I digestion of cytochrome oxidase I region is not a diagnostic test for A. m. lamarckii

Restriction fragment length polymorphism of whole mitochondrial DNA or PCR amplified mtDNA regions are known to be useful in discriminating among honey bee lineages and also some individual subspecies. In this study, PCR-amplified fragments of cytochrome oxidase I (CO-I) and cytochrome B (Cyt B) of honey bees sampled from different countries (Cyprus, Turkey, Ethiopia, Syria and Egypt) were digested with Hinf I and Bgl II restriction enzymes, respectively. Eastern Europe and Mediterranean honey bee subspecies were separated by the Cyt B/Bgl II analysis, although Hinf I digestion of the CO-I region yielded much finer resolution within different honey bee lineages. Here we report that CO-I/Hinf-I is a discriminative test for the mitochondrial "O" lineage, rather than a diagnostic site for A. m. lamarckii.

Aspiracão de corpo estranho através de traqueotomia: descricão de um caso / Foreign body aspiration through tracheotomy: a case report

Paciente de 70 anos, sexo masculino, traqueotomizado há cerca de 7 anos devido a tumoracão laríngea. Durante o procedimento de limpeza da cânula aspirou, acidentalmente, um fragmento da escova de limpeza. Radiografia de tórax em PA evidenciou corpo estranho metálico em topografia de brônquio inferior direito. Realizada broncoscopia rígida sob anestesia geral, com passagem do tubo pelo espaco glótico, sem resistências, procedeu-se a remocão do corpo estranho, sem complicacões. O paciente evoluiu assintomático, sendo encaminhado ao servico de ORL em que fazia acompanhamento para reavaliacão do caso.

Development of a control alternative for the citrus fruit borer, Ecdytolopha aurantiana (Lepidoptera, Tortricidae): from basic research to the grower

São descritas todas as etapas da pesquisa, desenvolvidas de 1995 a 2000, para a síntese do feromônio sexual de Ecdytolopha aurantiana (Lima, 1927), visando ao monitoramento desta praga que causa perdas da ordem de 50 milhões de dólares ao ano à citricultura paulista. As pesquisas básicas são apresentadas, incluindo o desenvolvimento de uma dieta artificial para o inseto, estudo de suas exigências térmicas e hídricas, estudos comportamentais, síntese da substância atraente para o macho desde a formulação até a distribuição do feromônio ao agricultor, e a sua comercialização. Trata-se de um caso de sucesso, a um custo de 50 mil dólares, com pesquisas inter- e multidisciplinares e que pode ser adotado para outros insetos-praga do país.

Otite externa difusa aguda: um estudo prospectivo no verão do Rio de Janeiro / Acute diffuse external otitis: a prospective study in Rio de Janeiro's summer

A Otite Externa Aguda é uma doença extremamente comum em países tropicais, especialmente no verão. Vários fatores predisponentes são identificáveis e o quadro clínico pode ser bastante variado, principalmente com relação à intensidade da otalgia. OBJETIVO: Avaliar, através de um estudo prospectivo no maior hospital de Emergências do Rio de Janeiro, a incidência e as características da otite externa no período de verão. FORMA DE ESTUDO: Estudo clínico com coorte transversal. MATERIAL E MÉTODO: 391 pacientes com otite externa atendidos no Serviço de ORL do Hospital Souza Aguiar foram avaliados em uma série de parâmetros clínicos e de tratamento, incluindo análise de possíveis fatores predisponentes. RESULTADOS: Os principais sintomas referidos foram otalgia, otorréia discreta e plenitude auricular. Os principais fatores predisponentes foram banho de mar e piscina e uso de cotonetes. CONCLUSÃO: A otite externa aguda é uma doença extremamente comum em países tropicais, especialmente no verão. A possível contaminação da água de praias e piscinas, embora descartada por vários autores como fatores predisponentes, pode ter alguma influência na sua patogênese.