Gill and hepatic histological alterations in Sciades herzbergii resulting from trace element contamination in the Port of São Luiz, Brazil.

The objective of this study was to evaluate, through changes in the gills and livers of Sciades herzbergii, the environmental contamination to which estuarine organisms are exposed in two areas in São Marcos Bay - MA. Two collection areas located in São Marcos Bay were selected for this study: A1, an area close to the Port Complex, and A2, an area on Caranguejos Island (included in the Environmental Protection Area of Baixada Maranhense). Collections were carried out during rainy and dry periods. Sediments (for trace element analyses), surface water (for physico-chemical analyses), and specimens of S. herzbergii (for biometric measurements and identification of branchial and hepatic histopathology) were collected. Physico-chemical parameters (pH, dissolved oxygen, temperature and salinity) were within limits established by Brazilian legislation. Arsenic (in A1) and nickel (in A1 and A2) were above the legal standards in both periods. The highest percentage of histological alterations in the gills (aneurysms, lamellar fusion and detachment of the epithelium) occurred in the port area, in the rainy (93%) and dry (74%) periods. Liver alterations (melanomacrophage centers and necrosis) occurred only in specimens from the same area, in the rainy (41%) and dry (36%) periods. The highest histological indices of gill and liver changes were recorded in A1. This result was further supported by the total HI value of the lesions, which was higher in the port area compared to A2 (less impacted area), suggesting that the environmental conditions in that location are less favorable for the well-being of these organisms. Permanent environmental monitoring of the area is necessary to control environmental impacts efficiently.

Tuberculosis among South American immigrants in São Paulo municipality: an analysis in space and time.

OBJECTIVE: To identify spatial and temporal, and spatial variation in temporal trends in clusters of tuberculosis (TB) among South American migrants residing in São Paulo municipality, SP, Brazil, between 2006 and 2013. DESIGN: An ecological descriptive study was conducted using data obtained from official TB reports and the 2010 Brazilian demographic census. Clusters were identified using scan statistics and SaTScan software; those with P < 0.05 were considered statistically significant. Social and economic characteristics of residents within the clusters were investigated. RESULTS: One high-risk spatial cluster (relative risk [RR] 4.46, P < 0.001) for TB was identified. Bolivian immigrants comprised the majority of immigrants residing in this area. One purely temporal high-risk cluster was identified between 2011 and 2013 (RR 1.55, P = 0.001). In one of the spatial variation in temporal trends clusters, the annual increase in TB incidence was 17.54% inside the cluster and 5.17% outside. CONCLUSIONS: We found areas of high risk for TB among South American immigrants. These areas and those with increasing trends of TB incidence must be prioritised by TB control programmes.

Limb salvage using bypass to the perigeniculate arteries.

OBJECTIVE: To describe bypass to perigeniculate vessels for limb salvage. DESIGN: Retrospective cohort study. MATERIAL AND METHODS: Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases. RESULTS: There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively. CONCLUSION: Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.

Inframalleolar bypass grafts for limb salvage.

OBJECTIVE: To report our experience of long-term results of inframalleolar bypass. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We analysed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Most patients were treated for critical ischaemia (97%). The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3%) and the greater saphenous vein (84.4%) as the conduit. The follow-up periods ranged from 1 to 60 months. The endpoints analysed were graft patency, limb salvage, preservation of deambulation and survival rate. RESULTS: The cumulative patency was 58.2% at 3 years and 53.4% at 5 years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation rates of 57.3% and 47.1%, respectively. There were 36 major and 45 minor amputations. At 3 years, the survival rate was 50.2% and the surgical mortality 13%. Female sex was associated with worse results for cumulative patency and limb salvage (P<0.01). CONCLUSIONS: In the long term, inframalleolar bypass is a satisfactory option for limb salvage.

Potential agents to control enamel caries-like lesions.

OBJECTIVES: To assess whether pastes containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and calcium sodium phosphosilicate (CSP) control artificial caries lesion progression. METHODS: Enamel slabs of bovine teeth were embedded in polyester resin and had their enamel surfaces serially polished, and tested for surface microhardness (SMH, 25 g, 5 s). Incipient caries-like lesions were pre-formed and specimens were evaluated by microhardness test (SMH(post-lesion)) and randomly assigned to five treatment groups (n=15): (1) regular dentifrice (RE, 1,100 ppm F); (2) dentifrice with calcium sodium phosphosilicate (CSP); (3) amorphous calcium phosphate stabilized by casein phosphopeptide (CPP-ACP); (4) CPP-ACP with 900 ppm F (CPP-ACP+F) and (5) control group-unexposed to any remineralizing agent. Treatments were applied five times, after the de-remineralization period in the cariogenic challenges. Post-treatments SMH measurements were conducted (SMH(post-treatment)). RESULTS: ANOVA was applied for data evaluation and revealed a significant difference among the treatments (p=0.0161). Tukey's test was conducted and the percentage of mineral loss was calculated. Specimens exposed to CSP (7.1%), RE (6.7%) and CPP-ACP+F (3.8%) showed lower mineral loss than those that in the control group (-11.0%). CPP-ACP group (3.2%) differed from the control, CSP and RE groups. CONCLUSIONS: Depending on the agent used, a remineralizing effect may be expected, which reflects in caries lesions progression.

Bilateral dentigerous cysts: review of the literature and report of an unusual case.

Dentigerous cysts are common cysts of the jaws. They are associated with the crowns of permanent teeth, most frequently associated with impacted mandibular third molars. Bilateral dentigerous cysts are rare and generally occur in association with a developmental syndrome or systemic disease, such as mucopolysaccharidosis and cleidocranial dysplasia. Bilateral dentigerous cysts in the absence of a syndrome are rare and to date only 17 cases have been described. The following is a report of a case of unusual bilateral non-syndromic dentigerous cysts associated with mandibular second molar and maxillary third molar and a review of the literature. Bilateral dentigerous cysts in these locations have not been previously reported.

The distal zone of the deep femoral artery as the inflow site in femorodistal bypass grafting.

The distal zone of the deep femoral artery has been used as an inflow site for femorodistal bypass grafts. Eleven such bypass grafts were performed in patients who had critical limb ischemia either to avoid a hostile groin (n=7) or because of an insufficient length of vein (n=4). The posteromedial route was used. Two of the 11 grafts had early failure and a third failed at 3 months: redo surgery restored arterial blood flow to the limb in all three patients. The procedure was safe and is a widely applicable, effective alternative that extends the limits of infrainguinal vein bypass grafting.

Prospective comparison of arm veins and greater saphenous veins as infrageniculate bypass grafts.

OBJECTIVES: to compare arm and saphenous veins for infrageniculate bypass grafting. DESIGN: prospective non-randomised study. MATERIALS: two hundred patients, of which 197 had ischaemic tissue loss or rest pain. METHODS: two hundred and eleven infrageniculate vein bypass procedures using 176 greater saphenous veins and 35 arm veins. RESULTS: the cumulative primary graft patency rate at 1-month and 2 years was 80% and 61% for saphenous vein and 89% and 42% for arm vein. The corresponding rates for secondary patency were 84.5% and 68%, and 91% and 57%, respectively. These results corresponded to a relative risk of secondary failure of 1.53 (95% CI 0.71, 3.31) for arm vein grafts. In subgroup analyses, this estimate was 0.93 and 2.1 for primary vs secondary bypasses and 0.38 and 2.06 for single-vein vs spliced-vein bypasses. Among arm veins, cephalic vein grafts performed better than basilic vein grafts. Early mortality was 14% for arm vein and 10% for saphenous vein. CONCLUSION: in the setting of infrageniculate bypass grafting, arm vein grafts are not equivalent to greater saphenous vein grafts, but contribute importantly to a policy of using autologous veins. The possibility of equivalence remains for the arm vein graft that uses a cephalic vein or is a primary procedure.

Resultados das derivaçöes infra-inguinais até segmento isolado de artéria / Results of infra-inguinal by-passes to isolated artery segment

Os autores apresentam sua experiência com 23 casos operados e nos quais foi feita revascularização do membro inferior por meio de derivaçöes em que a anastomose distal foi implantada num segmento isolado de artéria. A perviedade cumulativa no grupo em que foram usadas próteses (7 casos), a taxa foi de 21 'por cento'. Os resultados obtidos quanto à preservação do membro foram elevados, sendo de 81 'por cento' e 87 'por cento' respectivamente para as lesöes estáveis e instáveis.

Effect of coumarin on growth and metabolism of Pythium.

Coumarin concentrations that inhibited growth of Pythium sp. rapidly decreased the rate of incorporation of [14C]glucose into the mycelium. Coumarin also reduced drastically the carbohydrate and protein content of the cytoplasm and, to a lesser extent, the amino acid content and cell wall fraction. Enzymes related to the metabolism of cell wall polysaccharides were not affected during early exposure to the inhibitor. The possible mechanism of coumarin action via inhibition of glucose uptake is discussed in the light of the present findings.