Large cervical fibroid: a rare case report

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases.

Environmental constraints structuring fish assemblages in riffles: evidences from a tropical stream

ABSTRACT Riffles are unique habitats regarding to assemblage structure. However, understanding how these assemblages respond to environmental variations in small spatial extents, as within a stream, is a challenge. We assess whether the quantitative structure and the trophic composition of fish assemblages vary predictably among stream riffles. We predict that the variation of environmental conditions will explain species abundance and trophic composition, with the latter presenting higher predictive power, since species would be filtered according to their traits (e.g. diet). Moreover, we expect that the low among-riffle dispersal limitation within a stream and the strong habitat filtering would result in lower importance of spatial variables in the structure of riffle fish assemblages. We tested these predictions by studying 18 riffles of a stream in the Central Brazil. Environmental variables, but not spatial ones, were the most important in explaining the variation in assemblages structure. Environmental variables explained a greater portion of the trophic structure variation (R2=0.62) than of abundance (R2=0.37), indicating that the variation on the trophic traits at community level are more predictable. These results also indicate that these assemblages are subject to environmental control, highlighting the importance of riffle characteristics in driving ecological processes within streams.

RESUMO Corredeiras são habitats singulares no que se refere à estrutura das suas assembleias. Entretanto, a compreensão sobre como essas assembleias respondem às variações ambientais em pequenas extensões espaciais, como dentro de um riacho, ainda é um desafio. Avaliamos se a estrutura quantitativa das assembleias de peixes, assim como a sua composição trófica variam previsivelmente entre corredeiras de riachos. Predizemos que a variação nas condições ambientais explicará a abundância das espécies, assim como a sua composição trófica, entretanto, com uma maior proporção da variação explicada para a segunda, já que as espécies seriam filtradas de acordo com seus atributos (e.g. dieta). Além disso, esperamos que a pequena limitação para a dispersão entre as corredeiras de um mesmo riacho, associada à forte filtragem ambiental, resultaria em uma menor importância de variáveis espaciais na estruturação das assembleias de corredeiras. Para testar essas predições, estudamos 18 corredeiras de um rio do Brasil Central. As variáveis ambientais, e não as espaciais, foram mais importantes para explicar a variação na estrutura das assembleias. As variáveis ambientais explicaram uma maior proporção da variação da composição trófica (R2=0,62), em comparação com a abundância (R2=0,37), indicando maior previsibilidade na variação dos atributos relacionados a dieta em nível de comunidade. Esses resultados também indicam que essas assembleias são sujeitas a forte controle ambiental, destacando a importância das características desses habitats nos processos ecológicos dentro dos riachos.

Arachnoid Membrane Suturing for Prevention of Subdural Fluid Collection in Extracranial-intracranial Bypass Surgery

OBJECTIVE: Water-tight closure of the dura in extracranial-intracranial (EC-IC) bypass is impossible because the superficial temporal artery (STA) must run through the dural defect. Consequently, subdural hygroma and subcutaneous cerebrospinal fluid (CSF) collection frequently occur postoperatively. To reduce these complications, we prospectively performed suturing of the arachnoid membrane after STA-middle cerebral artery (STA-MCA) and evaluated the clinical usefulness. MATERIALS AND METHODS: Between Mar. 2005 and Oct. 2010, extracranial-intracranial arterial bypass (EIAB) with/without encephalo-myo-synangiosis was performed in 88 cases (male : female = 53 : 35). As a control group, 51 patients (57 sides) underwent conventional bypass surgery without closure of the arachnoid membrane. Postoperative computed tomography (CT) scan was performed twice in three days and seven days later, respectively, for evaluation of the presence of subdural fluid collection and other mass lesions. RESULTS: The surgical result was excellent, with no newly developing ischemic event until recent follow-up. The additional time needed for arachnoid suture was five to ten minutes, when three to eight sutures were required. Post-operative subdural fluid collection was not seen on follow-up computed tomography scans in all patients. CONCLUSION: Arachnoid suturing is simple, safe, and effective for prevention of subdural fluid collection in EC-IC bypass surgery, especially the vulnerable ischemic hemisphere.

Unusual Clinical Course of Giant Vertebral Artery Aneurysm after Proximal Artery Embolization: Case Report / 대한뇌혈관외과학회지

The authors present the case of a patient who suffered from cerebellar dysfunction, radiographically documented brainstem compression, and neurological deterioration after proximal artery occlusion in a giant vertebral artery aneurysm. Symptom resolution was achieved after complete embolization of remained lumen of aneurysm. The cause of neurological deterioration is brainstem compression due to mass effect of the aneurysm. In order to avoid this fatal complication, it is necessary to determine appropriate therapy for the vertebral artery giant aneurysm by evaluating cerebral blood flow and other factors about growth of aneurysm.