Local ecological knowledge and scientific data reveal overexploitation by multigear artisanal fisheries in the southwestern Atlantic.

In the last decades, a number of studies based on historical records revealed the diversity loss in the oceans and human-induced changes to marine ecosystems. These studies have improved our understanding of the human impacts in the oceans. They also drew attention to the shifting baseline syndrome and the importance of assessing appropriate sources of data in order to build the most reliable environmental baseline. Here we amassed information from artisanal fishermen's local ecological knowledge, fisheries landing data and underwater visual census to assess the decline of fish species in Southeastern Brazil. Interviews with 214 fishermen from line, beach seine and spearfishing revealed a sharp decline in abundance of the bluefish Pomatomus saltatrix, the groupers Epinephelus marginatus, Mycteroperca acutirostris, M. bonaci and M. microlepis, and large parrotfishes in the past six decades. Fisheries landing data from a 16-year period support the decline of bluefish as pointed by fishermen's local knowledge, while underwater visual census campaigns show reductions in groupers' abundance and a sharp population decline of the Brazilian endemic parrotfish Scarus trispinosus. Despite the marked decline of these fisheries, younger and less experienced fishermen recognized fewer species as overexploited and fishing sites as depleted than older and more experienced fishermen, indicating the occurrence of the shifting baseline syndrome. Here we show both the decline of multigear fisheries catches - combining anecdotal and scientific data - as well as changes in environmental perceptions over generations of fishermen. Managing ocean resources requires looking into the past, and into traditional knowledge, bringing historical baselines to the present and improving public awareness.

Pyoderma gangrenosum: the great pretender and a challenging diagnosis.

BACKGROUND: The initial presentation of pyoderma gangrenosum (PG) is virtually indistinguishable from a pyogenic infection, making débridement appear necessary. However, operative approaches often lead to exacerbation and rapid extension through pathergy. OBJECTIVE AND METHODS: In attempts to increase awareness of this condition and minimize misdiagnoses, a review of published reports involving PG of the hand and digits was performed and included 35 patients in addition to our case of a 14-year-old female with a history of ulcerative colitis. RESULTS: Of the total cases, 29 patients were misdiagnosed as having an infection and subsequently treated with antibiotics; 13 of these patients also had débridement of their lesions. Twenty-eight patients had associated medical conditions, including ulcerative colitis, Crohn disease, diabetes mellitus, and cancer. CONCLUSION: When approached with a rapidly growing ulcerated lesion that does not respond to operative therapy, the possibility of PG should be entertained and a high-dose corticosteroid regimen and/or immunomodulator therapy implemented.

Tendon transfers for radial, median, and ulnar nerve injuries: current surgical techniques.

Tendon transfers are performed predominantly to restore hand function or balance due to injuries of the radial, median, and ulnar nerves. Current surgical techniques for the most common tendon transfers for reconstruction of radial, median, and ulnar nerve palsies are demonstrated. These techniques can also be applied to restore flexion and extension of the fingers and thumb after injuries to the extrinsic flexor and extensor muscles and tendons of the forearm or intrinsic muscles of the hand.

Transverse ulnar forearm flap.

INTRODUCTION: The transverse ulnar forearm flap (TUFF) was used to reconstruct different recipient sites in 5 consecutive cases based on the specific requirement for a small thin, hairless flap with a long pedicle. Recent studies have clarified the benefits of the ulnar forearm flap: a less inconspicuous donor site and a primary donor site closure with a radially based fasciocutaneous flap. METHODS: The TUFF is designed with its long axis transverse and distal margin parallel with a wrist flexion crease. An incision is extended proximally along the ulnar artery pedicle as far as the takeoff from the brachial artery if needed. After elevating the ulnar forearm flap in the standard fashion, transverse primary closure of the donor site is obtained by elevating a large volar forearm fasciocutaneous flap based on the radial artery and advanced distally with a V-Y advancement. Any dog ear is tailored, and the wrist is flexed at 30 degrees. RESULTS: All TUFF and radial fasciocutaneous flaps survived completely without partial or total losses or ischemic hand complications. One patient had a wide scar at the proximal forearm Y junction that was revised. Two-point fingertip discrimination and range of motion were satisfactory. CONCLUSIONS: The TUFF is a synthesis of variations of previously described forearm flap techniques and provides a specialized flap in situations where small, thin, pliable, hairless fasciocutaneous flap with a long vascular pedicle are necessary. These characteristics make it appropriate in orbital reconstruction and palatal surgery.

Transanal endoscopic repair of rectal anastomotic defect.

Surgeons often encounter difficulty when constructing a colorectal anastomosis in the "hostile pelvis." Examples include performing low anterior resection or colostomy takedown in the setting of prior radiation, severe inflammation, or a narrow pelvis. Circular staplers have made low anastomosis a viable alternative to permanent colostomy in these situations. However, the surgeon may occasionally be faced with the difficult decision of how to manage a gross disruption of a stapled anastomosis in a pelvis that will not permit anastomotic redo. The traditional approach to this would be creating a permanent colostomy. We describe an alternate approach: endoscopic suturing with protecting ileostomy. We have successfully applied this technique to 4 patients with gross anastomotic disruption in a hostile pelvis. All patients tolerated the procedure well and have maintained normal bowel function without the need for a permanent colostomy.

Radiofrequency ablation of liver metastasis from ovarian adenocarcinoma: case report and literature review.

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive technique that can eradicate malignant disease in the liver, including metastatic disease from gynecological primary tumors. CASE: An 81-year-old female underwent percutaneous RFA for a solitary intrahepatic metastatic lesion that was her only known site of disease 2 years after definitive surgery and chemotherapy for stage IIIC ovarian adenocarcinoma. She was able to start systemic chemotherapy 1 week after RFA, and continues to be free of disease in the liver. CONCLUSION: RFA can be a useful tool for treating liver tumors in patients who would otherwise not be candidates for liver resection. Its advantages include minimal invasiveness, low morbidity, and rapid recovery for expeditious treatment with systemic chemotherapy.