Should we be afraid of watching sport events?

Funding Acknowledgements

Type of funding sources: None.

Background

Behavioral and emotional factors may trigger cardiovascular events (CVE). Watching sports when there is an emotional connection between the supporters and the supportive team, is believed to be potentially associated with CVE. However, epidemiological studies have been inconsistent, with several studies showing an increase in CVE, while others reporting a protective effect.

Purpose

To assess the effect of watching sport events on the incidence of cardiovascular events.

Methods

Pubmed, and Embase were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant articles. To be included, articles had to assess the association between CVE and sport events supporters (adeptos). Pooled association measures, using random effects analysis, were calculated for mortality; arrhythmias; myocardial infarction (MI). Subgroup analysis was conducted based on gender. Publication bias and between-study heterogeneity were evaluated.

Results

There were nineteen studies included in the analysis. The pooled relative risks for mortality, arrhythmias and MI were 1.45(0.98-2.15; 95%CI; I2=70%; p=0.02); 1.31(0.98-1.77; 95%CI; I2=85%; p<0.01); 1.11(0.98-1.24; 95%CI; I2=91%; p<0.01) respectively (Figure 1A). The null association persisted in the subgroup analyses by gender for mortality (Figure 1B) as well as for MI and for the combined endpoint MI/stroke (non significant relative risks).

Conclusions

Overall this analysis suggests that watching sport events does not increase cardiovascular events regardless of gender.

Observation of Betatron X-Ray Radiation in a Self-Modulated Laser Wakefield Accelerator Driven with Picosecond Laser Pulses

We investigate a new regime for betatron x-ray emission that utilizes kilojoule-class picosecond lasers to drive wakes in plasmas. When such laser pulses with intensities of ∼5×10^{18}  W/cm^{2} are focused into plasmas with electron densities of ∼1×10^{19}  cm^{-3}, they undergo self-modulation and channeling, which accelerates electrons up to 200 MeV energies and causes those electrons to emit x rays. The measured x-ray spectra are fit with a synchrotron spectrum with a critical energy of 10-20 keV, and 2D particle-in-cell simulations were used to model the acceleration and radiation of the electrons in our experimental conditions.

Seeded QED cascades in counterpropagating laser pulses

The growth rates of seeded QED cascades in counterpropagating lasers are calculated with first-principles two- and three-dimensional QED-PIC (particle-in-cell) simulations. The dependence of the growth rate on the laser polarization and intensity is compared with analytical models that support the findings of the simulations. The models provide insight regarding the qualitative trend of the cascade growth when the intensity of the laser field is varied. A discussion about the cascade's threshold is included, based on the analytical and numerical results. These results show that relativistic pair plasmas and efficient conversion from laser photons to γ rays can be observed with the typical intensities planned to operate on future ultraintense laser facilities such as ELI or Vulcan.

Application of high-content image analysis for quantitatively estimating lipid accumulation in oleaginous yeasts with potential for use in biodiesel production

Biodiesel from oleaginous microorganisms is a viable substitute for a fossil fuel. Current methods for microorganism lipid productivity evaluation do not analyze lipid dynamics in single cells. Here, we described a high-content image analysis (HCA) as a promising strategy for screening oleaginous microorganisms for biodiesel production, while generating single-cell lipid dynamics data in large cell density. Rhodotorula slooffiae yeast were grown in standard (CTL) or lipid trigger medium (LTM), and lipid droplet (LD) accumulation was analyzed in deconvolved confocal microscopy images of cells stained with the lipophilic fluorescent Nile red (NR) dye using automated cell and LD segmentation. The 'vesicle segmentation' method yielded valid morphometric results for limited lipid accumulation in smaller LDs (CTL samples) and for high lipid accumulation in larger LDs (LTM samples), and detected LD localization changes. Thus, HCA can be used to analyze the lipid accumulation patterns likely to be encountered in screens for biodiesel production.

All-optical radiation reaction at 10²¹ W/cm²

Using full-scale 3D particle-in-cell simulations we show that the radiation reaction dominated regime can be reached in an all-optical configuration through the collision of a ~1 GeV laser wakefield accelerated electron bunch with a counterpropagating laser pulse. In this configuration the radiation reaction significantly reduces the energy of the particle bunch, thus providing clear experimental signatures for the process with currently available lasers. We also show that the transition between the classical and quantum radiation reaction could be investigated in the same configuration with laser intensities of 10²³ W/cm².

Clinical evaluation of hepatic transection on pediatric liver transplantation

OBJECTIVES

Liver transplantation is an effective technique in the treatment of end-stage liver disease. The aim of this study was to evaluate the impact of hepatic transection, an advanced surgical technique able to tailor size to generate two grafts to from a single donor.

MATERIALS AND METHODS

A retrospective study between January 2000 and September 2013, reviewing 91 pediatric patients who underwent 96 liver transplants from deceased donors. Patients were distributed into two groups: whole organ (WO, n = 39) and transected liver grafts (TLG, n = 57). The following were evaluated: etiology, anthrophometric parameters (age, weight, height, z score weight/age, and height/age), model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD), previous surgeries, transfusion of blood components, 1-year survival rate, preoperative laboratory testing, from the second and seventh postoperative days, lactate during surgery, postoperative complications, duration of surgery, duration of cold and warm ischemia, types of biliary reconstruction, and laboratory testing of the donor.

RESULTS

The anthropometric values showed significant differences (P < .05) between the groups. The average age was 124.7 months in the WO group and 33.6 months in the TLG group (P < .0001), while the weight was 28.0 kg and 7.4 kg, respectively (P < .0001). The analysis of z score weight/age showed that the TLG had greater acute and chronic malnutrition, probably due to the etiology of liver disease, present from birth in patients as young. Red blood transfusion was higher in the TLG group (P < .0006) due to the cut surface of the graft, emphasizing the use and improvement of hemostatic techniques.

CONCLUSION

Despite differences between the groups, clinical and surgical complications were similar, showing that liver transection injury didn't change the results of transplantation. There was no impact on liver function, graft, or 1-year patient survival after liver transection. Second postoperative lactate is a predictive factor of death. Transection liver transplantation is an effective method as an alternative to pediatric liver transplantation.

Nitric oxide levels in the intestines of mice submitted to ischemia and reperfusion: L-arginine effects

OBJECTIVE

Usually an experimental necrotizing enterocolitis experimental model, we Investigated nitric oxide levels in intestinal tissues of newborn mice with or without l-arginine therapy during sessions of ischemia and reoxygenation.

METHODS

Twenty-six newborn mice from the Wistar EPM-1 lineage, weighing from 4.5 to 6.2 g, were randomly assigned to three groups: G-I/R, hypoxia and reoxygenation; G-Arg, l-arginine treatment I/R; and G-CTL, controls. G-I/R and G-Arg mice underwent twice a day during their first 3 days of life exposure to gas chambers with 100% CO(2) for 5 minutes at 22 degrees C before reoxygenation with 100% O(2) for another 5 minutes. After 12 hours, all animals were sedated, laparotomized, and had samples of ileum and colon taken and- either formalin fixed histopathologic examinations or frozen to -80 degrees C for estimation of tissue nitric oxide levels. Intestinal injuries were classified according to the criteria of Chiu et al.

RESULTS

The G-I/R and G-Arg groups showed injuries characteristic of necrotizing enterocolitis (NEC) with an improved structural preservation rate in G-Arg. The concentration of nitric oxide in the Ileum was much higher with G-Arg (16.5 +/- 4.9; P = 0.0019) G-I/R (7.3 +/- 2.0). This effect was not observed in the colon: G-I/R = 10.7 +/- 4.6 versus G-Arg = 15.5 +/- 8.7 (P = .2480).

CONCLUSION

Supply of L-arginine increased tissue levels of nitricoxide and reduced morphologic intestinal injury among mice undergoing I/R.

Study of density of interstitial cells of cajal in the terminal intestine of rats with anorectal malformation

INTRODUCTION

Intestinal constipation is one of the most commonly occurring complaints in the postoperative period after correction of anorectal malformation (ARM). An abnormal density of interstitial cells of Cajal (ICC) is one potential cause. The objective of this study was to analyze the density of ICC in the terminal intestine of fetuses of rats with anorectal anomaly induced by ethylenethiourea (ETU).

MATERIAL AND METHODS

The fetuses were distributed into three groups: Group A--normal fetuses obtained from pregnant female rats that did not receive ETU; Group B--fetuses with no ARM, obtained from pregnant rats that received ETU, and Group C--fetuses with ARM, obtained from pregnant rats that received ETU. ETU was administered on the 11th day of pregnancy at a dose of 125 mg/kg. The fetuses were extracted by means of laparotomy on the 21st day of pregnancy. The terminal intestine of the fetuses was removed and analyzed by immunohistochemistry to evaluate ICC.

RESULTS

Statistically significant differences were found between groups A, B and C regarding the density of ICC. Group A presented with the highest density, followed by groups B and C.

CONCLUSION

There is a lower density of ICC in the terminal intestine of rats with ARM.

'Candidatus Magnetoglobus multicellularis', a multicellular, magnetotactic prokaryote from a hypersaline environment

Phylogenetic analysis and phenotypic characterization were used to assign a multicellular magnetotactic prokaryote the name 'Candidatus Magnetoglobus multicellularis'. 'Candidatus Magnetoglobus multicellularis' lives in a large hypersaline coastal lagoon from Brazil and has properties that are unique among prokaryotes. It consists of a compact assembly or aggregate of flagellated bacterial cells, highly organized in a sphere, that swim in either helical or straight trajectories. The life cycle of 'Candidatus Magnetoglobus multicellularis' is completely multicellular, in which one aggregate grows by enlarging the size of its cells and approximately doubling the volume of the whole organism. Cells then divide synchronously, maintaining the spherical arrangement; finally the cells separate into two identical aggregates. Phylogenetic 16S rRNA gene sequence analysis showed that 'Candidatus Magnetoglobus multicellularis' is related to the dissimilatory sulfate-reducing bacteria within the Deltaproteobacteria and to other previously described, but not yet well characterized, multicellular magnetotactic prokaryotes.

Deep-Etching Electron Microscopy of Cells of Magnetospirillum magnetotacticum: Evidence for Filamentous Structures Connecting the Magnetosome Chain to the Cell Surface

Magnetospirillum magnetotacticum are magnetotactic bacteria that form a single chain of magnetite magnetosomes within its cytoplasm. Here, we studied the ultrastructure of M. magnetotacticum by freeze-fracture and deep-etching to understand the spatial correlation between the magnetosome chain and the cell envelope and its possible implications for magnetotaxis. Magnetosomes were found mainly near the cell envelope, forming chains that were closely associated with the granular cytoplasmic material. The membrane surrounding the magnetosomes could be visualized in deep-etching preparations. Thin connections between magnetosome chains and the cell envelope were observed in deep-etching images. These results strengthen the hypothesis for the existence of structures that transfer the torque from the magnetosome chains to the whole cell during the orientation of magnetotactic bacteria to a magnetic field lines.

Can bacterial translocation be a beneficial event?

Infection is a major concern in intestinal transplant recipients. Bacterial migration to extraintestinal sites is a central component of the gut hypothesis of sepsis. However, some studies have cited the beneficial effects of bacterial translocation (BT) on the host acquired immune system. We evaluated the role of previous BT on a subsequent BT challenge, examined the BT index in organs as well as changes in white blood cell (WBC) count in mesenteric lymph and blood for correlation with outcomes. Wistar rats (n = 60) were divided into a BT group (n = 20), which underwent inoculation of 10 mL of 10(10) CFU/mL Escherichia coli R-6 confined to the small intestine as opposed to a BT1-14 group (n = 20), which underwent the BT procedure on days 1 and 14 or a S1-BT14 group (n = 20) that received 10 mL of saline on day 1 and the BT procedure on day 14. Half of the animals were killed 2 hours following the BT procedure. Samples from different compartments were collected for culture. Mesenteric lymph and peripheral blood were examined for WBC counts. The other half of the hosts was subjected to outcome evaluation concerning weight gain and mortality. Animals undergoing double BT showed a significantly lower index of bacterial recovery (liver, spleen, and blood) compared with those having a single BT (P < .05). The WBC count of mesenteric lymph cells after double BT was similar to naïve animals, but significantly lower than the single BT group (P < .05). The outcome was unchanged among double BT versus other groups. A previous BT challenge was efficient to generate a host-defense mechanism against a second BT episode induced by intestinal overgrowth with the same bacterial strain.

In vitro inhibition of Streptococci binding to enamel acquired pellicle by Plant Lectins

AIM

Initial colonization of the tooth surface by streptococci involves the attachment of these bacteria to adsorbed salivary components of the acquired pellicle. In dental biofilm this adhesion may also involve lectin-like components, present on the surface of the organisms, which bind to complementary carbohydrates on the surface of the tooth. Therefore, this work aimed to evaluate the potential of six lectins, extracted from seeds of Leguminosae family members, to inhibit the adherence of five streptococci species to acquired pellicle in vitro.

METHODS AND RESULTS

The lectins used in this work were extracted from Canavalia ensiformis, Canavalia brasiliensis, Dioclea violacea, Dioclea grandiflora, Cratylia floribunda and Vatairea macrocarpa. Fluorescence micrography was employed to visualize the ability of FITC-labeled lectins to attach to acquire pellicle. Adherence inhibition was performed on saliva-coated microtiter plates at which lectins solutions were previously incubated followed by incubation with the oral streptococci. Glucose-mannose specific lectins attached to acquired pellicle with high intensity, while galactose specific lectins, from V. macrocarpa, exhibits low intensity attachment.

CONCLUSIONS

All lectins were able to inhibit the adherence of the microorganisms tested (p < 0.01).

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results suggest that lectins may be useful in anti adhesion therapeutics.

Insights into the role of gp63-like proteins in lower trypanosomatids

Any actual understanding of trypanosomatids in general requires a comprehensive analysis of the less-specialized species as thorough as our knowledge of the more specialized Leishmania and Trypanosoma. In this context, we have shown by antibody cross-reactivity that purified extracellular metallopeptidases from Phytomonas françai, Crithidia deanei (cured strain) and Crithidia guilhermei share common epitopes with the leishmanial gp63. Flow cytometry and fluorescence microscopy analyses indicated the presence of gp63-like molecules on the cell surface of these lower trypanosomatids. Binding assays with explanted guts of Aedes aegypti incubated with purified gp63 and the pretreatment of trypanosomatids with anti-gp63 antibodies indicated that the gp63-like molecules are involved in the adhesive process of these trypanosomatids to the A. aegypti gut wall. In addition, our results indicate for the first time that the gp63-like molecule binds to a polypeptide of 50 kDa on the A. aegypti gut epithelium extract.

Repercussions of extensive small bowel resections in growing rats

OBJECTIVE

To study the effects of extensive intestinal resection on growing rats, with regard to animal weight and histomorphometry of the remaining small intestine.

METHODS

Forty growing rats were allocated according to the extent of small intestine resection: 60%, 70%, 80%, or 90%. The animals were weighed every week and observed for 30 days. Following sacrifice the remaining small intestine was resected, fixed in 10% formol for 24 hours, embedded in paraffin, and stained using hematoxylin and eosin. The histological changes in the remaining small intestine were assessed for the length and thickness of villi, the thickness of the muscle layer, and the number of intestinal glands.

RESULTS

All growing rats showed a fall in body weight, although it was more significant with the largest intestinal resection (80% and 90%). Villus length and muscle thickness increased after 30 postoperative days in all rats, but the number of intestinal glands remained unaltered.

CONCLUSION

Growing rats with greatest resection of small intestine (80% and 90%) had better intestinal adaptation and slower recovery of body weight.

Rapid access arrhythmia clinic for the diagnosis and management of new arrhythmias presenting in the community: a prospective, descriptive study

OBJECTIVE

To investigate whether a rapid access approach is useful for the evaluation of patients with symptoms suggestive of a new cardiac arrhythmia.

DESIGN

Prospective, descriptive study.

SETTING

Secondary care based rapid access arrhythmia clinic in West London, UK.

PARTICIPANTS

Patients referred by their general practitioner or the emergency department with symptoms suggestive of a new cardiac arrhythmia.

MAIN OUTCOME MEASURES

Number of patients with a newly diagnosed significant arrhythmia. Number of patients with diagnosed atrial fibrillation. Number of eligible, moderate, and high risk patients treated with warfarin.

RESULTS

Over a 25 month period 984 referrals were assessed. The mean age was 55 years (range 20-90 years) and 56% were women. The median time from referral to assessment was one day. A significant cardiac arrhythmia was newly diagnosed in 40% of patients referred to the RAAC. The most common arrhythmia was atrial fibrillation, with 203 new cases (21%). Of these, 74% of eligible patients over 65 were treated with warfarin. Other arrhythmias diagnosed were supraventricular tachycardias (127 (13%)), conduction disorders (43 (4%)), and non-sustained ventricular tachycardia (21 (2%)). Vasovagal syncope was diagnosed for 53 patients (5%). The most frequent diagnosis was symptomatic ventricular and supraventricular extrasystoles (355 (36%)).

CONCLUSION

A rapid access arrhythmia clinic is an innovative approach to the diagnosis and management of new cardiac arrhythmias in the community. It provides a rapid diagnosis, stratifies risk, and leads to prompt initiation of effective treatment for this population.

Helicoidal enteromyotomy in rats: an experimental model of intestinal lengthening

Short bowel syndrome (SBS) is a congenital or acquired condition of poor absorption resulting from a reduced surface of the enteric mucosa. In most cases, it spontaneously resolves via an adaptive process in the remaining intestine. Intestinal lengthening is one therapeutic method used for refractory SBS. The present study evaluates the intestinal changes and weight gains following a new lengthening technique (helicoidal enteromyotomy) performed in growing rats. Thirty Wistar rats underwent enteromyotomy (group I) in a 5-cm jejunal segment or laparotomy only (group II). No animal underwent intestinal resection. Postoperatively monitored weight was animals were sacrificed on the day 28. Measurements were made of the anterior and middle half-perimeters and the length of the marked-out intestinal segment. Two animals in group I were excluded due to infraction of the technique (perforation of the mucosa). Group I had an initial weight loss, although variance analysis (ANOVA) showed that the speed of the weight gain was similar in the two groups after the postoperative day 4 (P =.245). When the half-perimeter dimensions and length of the manipulated intestinal segment were compared, group I showed an increased caliber and length (P <.001, for both comparisons). There was no baseline difference in caliber between the two groups (P =.127). Our results led us to conclude that helicoidal enteromyotomy increases intestinal length and caliber without causing upstream dilatation or interfering in weight gain.

Anorectal anomaly associated with caudal regression: late evaluation after posterior sagittal anorectoplasty

The authors present a case of an anorectal anomaly associated with caudal regression syndrome, sirenomelia (mermaid syndrome), and a spectrum of mesodermal axial dysplasia. It was treated with a colostomy, posterior sagittal anorectoplasty, and closure of the colostomy. The patient is now 7-years-old, with fecal and urinary continence. Comments are made regarding the clinical and surgical findings, the follow-up evaluation, and anorectal manometry in this rare case.

Use of pyloric exclusion with a double jejunostomy in the treatment of a serious duodenal lesion in a child

A 3-year-old male was beaten by his stepfather, resulting in a lesion of the third portion of the duodenum that was treated with an occlusive suture of the pyloric mucosa for pyloric exclusion and a gastric-jejunal anastomosis with a double jejunostomy for alimentation with a good result, no serious complications, and relatively a short hospitalization. This procedure may be an alternative for other similar cases.

Posterior urethral injuries and the Mitrofanoff principle in children

OBJECTIVE

To report our experience of children with trauma causing posterior urethral injury who at some stage underwent a Mitrofanoff intervention, as post-traumatic urethral injuries can demand long-term treatment which (regardless of the surgical intervention) requires a period of dilatation of the reconstructed urethra.

PATIENTS AND METHODS

From 1992 to 2001, 14 patients with urethral injuries underwent a Mitrofanoff procedure. Thirteen had been run over by a motor vehicle and had severe hip injuries, and one had a direct non-penetrating perineal impact lesion (13 boys and one girl, aged 2-13 years at the time of the accident). In all cases the Mitrofanoff procedure involved interposing the appendix between the bladder and the umbilicus. Only one of the children (because of extremely high bladder filling pressures) also underwent an augmentation cystoplasty and closure of the bladder neck because there were bony fragments in the urethra.

RESULTS

The Mitrofanoff technique was considered useful in most cases. All patients during a given period used the Mitrofanoff conduit to empty their bladder every 3 h; 10 of the 14 are currently voiding urethrally, with an adequate flow, and four are not, but emptying the bladder periodically via the appendicovesicostomy. The only girl in the group has a major hip deformity and is unlikely to undergo urethroplasty; two patients are expecting definitive treatment and the other, although having a patent urethra, has no urinary flow. He is currently 19 years old and has no erections.

CONCLUSIONS

The treatment of posterior urethral injuries represents a challenge to surgical teams. Although primary suturing of the separated urethral ends is accepted as the best treatment, the construction of a temporary continent urinary diversion may be considered in the most severe cases.

Neonatal acute appendicitis: a strangulated appendix in an incarcerated inguinal hernia

A 4-day-old infant with acute appendicitis (AA) due to incarceration of a right inguinal hernia is presented. Although appendicitis is the most common condition requiring abdominal surgery, the reported occurrence of AA subsequent to neonatal hernia incarceration is exceptionally rare.

Cecal duplication causing a disappearing abdominal mass in an infant

Duplications of the alimentary tract are rare malformations. A case of a 2-year-old girl with an intestinal intussusception caused by a cystic duplication of the cecum is presented. This case report is justified by its clinical features and the difficult diagnosis, which was only confirmed during surgery. Ultrasonography had documented an abdominal mass that then disappeared and later reappeared, leading to surgical indication. During surgery, the intussusception within the abdomen was reduced, and right hemicolectomy was performed around the mass in the interior part of the cecum and appendix, with ileocolic anastomosis. On resecting the cecum, a cystic duplication measuring 4 x 3 cm was observed, with a granular mucous layer, an ulcerated hole in its interior, and inflammatory reaction. The patient had an uneventful recovery and was discharged on the fourth postoperative day.

[Effects of partial colonic resection in rats]

In order to study the effects of partial colectomy, 30 rats Wistar were divided into three groups: GI and GII had the cecun and the ileo cecal valve resected and proximal colectomy was performed in GI and distal in GII. GIII had distal colectomy without cecum resection. The length of the remain colon was of 5 cm in all groups. Colostomy was performed in GI, GII and GIII. Parameters evaluated: body weight, fecal composition concerning to water, lipids and proteins on preoperative time and on the 10th, 20th, 30th, 40th, 50th and 60th days of postoperative time. All statistical tests were conducted at a 5% two-sided risk level. The evaluation was made by analysis of variance techniques.

CONCLUSIONS

Concerning to body weight, there is no significant difference on the late postoperative time in any group or when comparing the three groups on this same period. On late postoperative time, GI and GII had a large amount of fecal water, lipids and proteins when compared to the preoperative time and to GIII. On the 60th day there's no significant difference on the quantity of fecal water when comparing the three groups and the same occurs on the 50th day when considering the quantity of fecal proteins.

Clinical and radiological postoperative evaluation of posterior sagittal anorectoplasty in patients with upper and intermediate anorectal malformations

The PSARP is today the most-used surgical technique for correction of high and intermediary anorectal malformations. There is much controversy in the literature about the post-operative evaluation of these cases. We studied 27 cases of anorectal malformations from clinical and radiological aspects, in order to analyse: 1. Fecal continence 2. Relationship between post-operative fecal continence and the associated sacral anomalies 3. Relationship between the radiological evaluation by defecogram and fecal continence From the analysis of the cases, we concluded: 1. Fecal continence was achieved in 48.14% of the cases; partial continence in 25.92%; and fecal incontinence in 25.92% of the cases. 2. The presence of fecal incontinence was directly related to the associated sacral anomalies.

[Hepatic mesenchimal hamartoma in neonates]

OBJECTIVES

To approach the diagnosis and management of two different features of hepatic mesenchymal hamartoma (HMH) in the neonate.

METHODS

Report of two cases of HMH in newborns and review of the literature (MEDLINE and LILACS).

RESULTS

Two cases of newborns with huge abdominal masses are presented, one of them complicated by rupture and hemorrhage during ultrasound manipulation, leading to hypovolemic shock. Urgent operation showed a ruptured giant hepatic cyst containing hemorrhagic yellowish fluid. The cyst was removed by edge resection at the level of hepatic segment 6 and the postoperative period was uneventful. The pathological analysis of the cyst including immunohistochemical tests revealed HMH. In case 2, with prenatal diagnosis of hepatic tumor, the mass progressively enlarged after birth, and a left hepatectomy was performed. The macroscopic appearance suggested hemangioma but the histopathological aspect indicated mesenchymal hamartoma with endothelial predominance. Nowadays both children are healthy and asymptomatic.

CONCLUSIONS

The management of HMH is surgical treatment, because it does not disappear spontaneously. Some cases evolve to giant forms even in the neonatal period leading to fatal complications. Preoperative differential diagnosis from hemangioma is quite difficult for cystic types, and immunohistochemical analysis is important for pathological confirmation.

Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagittal anorectoplasty (PSARP)

OBJECTIVE

To evaluate biofeedback (BFB) responses to rehabilitation techniques and physical exercises in incontinent or partially continent anorectal malformations patients after posterior sagital anorectoplasty (PSARP).

DESIGN

Prospective study.

SETTING

Pediatric Surgery-Department of Surgery-UNIFESP-EPM.

PATIENTS

The authors report on 14 patients with anorectal malformations (4 with partial fecal incontinence after primary PSARP; 6 with fecal incontinence after primary PSARP; 3 with partial fecal incontinence after secondary PSARP; and 1 with fecal incontinence after secondary PSARP). All patients were rehabilitated via a BFB program of exercises in order to improve the function of the anal sphincteric muscular complex for a period of 1-3 years.

MAIN OUTCOME MEASURE

Clinical and manometric control.

RESULTS

After BFB, of 4 partially continent patients after primary PSARP, 3 became continent; of 6 incontinent patients after primary PSARP, 4 became continent; of 3 partially continent patients after secondary PSARP, 1 became continent, 1 showed no improvement and 1 became incontinent (infection + abscess + fibrosis + important anorectal stenosis). The incontinent patient after secondary PSARP showed no improvement.

CONCLUSION

The authors concluded that BFB, used at the appropriate time with patient collaboration, is an important complement to the anatomical reconstruction of anorectal malformations in order to achieve good development and contractile functioning of the sphincteric muscular complex.

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.

Electronic States of KxC60: Insulating, Metallic, and Superconducting Character

The recent report of electrical conductivity in the alkali metal fullerides and the discovery of superconductivity at 18 K for KxC(60) has raised fundamental questions about the electronic states on either side of the Fermi level, their occupancy with K intercalation, and the mechanism of superconductivity. Direct photoemission evidence is presented of filling of bands derived from the lowest unoccupied molecular orbital as a function of K incorporation for the metallic and insulating phases. This filling is not rigid band-like, and it reflects disorder in the K sites. Theoretical analysis indicates that KxC(60) is a strong coupling superconductor, and we suggest that the enhanced electron-phonon interaction is related to the unique hybridization of the C sp-derived states.