Integrated approach to the understanding of the degradation of an urban river: local perceptions, environmental parameters and geoprocessing.

BACKGROUND: The use of interdisciplinary approaches such as the proposed report provides a broad understanding of the relationship between people and the environment, revealing reliable aspects not previously considered in the study of this relationship. This study compiled evidence on the environmental degradation of an urbanized river over the past few decades, providing a diagnosis of the consequences of this process for the river, its ichthyofauna, and the local human population. METHODS: The study was focused on the Beira Rio community on the Capibaribe River in the municipality of São Lourenço da Mata, Pernambuco, Brazil. Data were collected using geoprocessing and ethnobiological approaches, as well as environmental parameters. This research was conducted with the most experienced long-term residents in the local community, through interviews and participatory methodologies to recovering information about the river environment, its ichthyofauna and its environmental services for the last decades. RESULTS: According to the GIS analysis, the study area was subject to an accelerated process of urbanization, with the total urban area increasing from 73 565, 98 m(2) in 1974 to 383 363, 6 m(2) in 2005. The informants perceived the urban growth, especially in the late twentieth century, being this period recognized as the phase of greatest negative changes in the river environment. The perceived decline of fish stocks was indicated by the community as one of the effects of river degradation. According to the interviews, the deterioration of the river affected the ecosystem services and the relationship of the adjacent human community with this ecosystem. The environmental data indicated that the river is suffering eutrophization and has fecal coliform concentrations 160 times higher than the maximum level permitted by Brazilian legislation. CONCLUSIONS: The interdisciplinary approach used in this research allowed the understanding of the degradation process of an urban river and some negative effects through the integration of environmental data, GIS and the local knowledge, revealing the complementarity of obtained data and the effectiveness of implementation of this approach.

Patients' satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap.

Immediate breast reconstruction with a latissimus dorsi musculocutaneous (LDM) flap is still not much reported, particularly in studies of patients' views. The aim of this study was to assess the level of patients' satisfaction with the technique. All patients (n = 257) who had had a mastectomy and immediate breast reconstruction with a LDM flap at a single hospital between January 1999 and December 2005 were identified, and 196 patients free of recurrence were included. The operations were done by the same surgical team in a standard manner. Clinical data, technical details, and outcome were collected prospectively. To assess the patients' degree of satisfaction with the aesthetic results in relation to clinical characteristics and treatment, a study-specific questionnaire and a visual analogue scale were sent to 196 patients; 178 forms were completed and returned. To analyse general satisfaction and aesthetic results we used the Mann-Whitney, Kruskal-Wallis, chi square, or Fisher's exact test, as appropriate. The median reconstruction follow-up period was 34 months. Patients who were 51 years or older at the time of reconstruction were less likely to opt for immediate breast reconstruction with LDM flap than younger patients. Patients who were divorced and those who had postoperative complications were less likely to be satisfied. One hundred and sixty-four patients (92%) were satisfied, and 161 (90%) said they would recommend the reconstruction. The median satisfaction score was 9 (range 1-10, mean 8.5). The technique provided satisfactory immediate breast reconstruction according to the patients' evaluation.

Quilting suture in the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction.

BACKGROUND: The purpose of this study was to evaluate the effects of quilting suture (placement of stitches between the superficial fascia in the supraumbilical remaining flap and the musculoaponeurotic layer of the anterior abdominal wall) at the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction. METHODS: There is a theory that the use of quilting suture, during the closure of the donor site with the abdominal flap, causes collapse of the dead space and enables the flap to rest, thus diminishing factors that may interfere in its adherence and help to reduce complications. Between January 2004 and March 2005, we performed 30 breast reconstructions using a unipedicled transverse rectus abdominis musculocutaneous flap. The sample was randomly distributed in 2 groups: 15 patients with quilting suture (group A) and 15 patients without quilting suture (group B). The study focused on daily drain output (mL), time to drain removal (days), and possible donor site complications (%). RESULTS: Group A presented an average of 4.2 days for removal of the drain and group B, 6.93 days, with a statistically significant difference (P < 0.001). Concerning the total volume upon removal of the drain, group A presented an average of 434.7 mL and group B, 620.7 mL, with a statistically significant difference (P = 0.002). Group A presented 13.3% complications at the donor site and group B, 53.3%, with a statistically significant difference (P = 0.05). CONCLUSIONS: The quilting suture in this study reduces the permanence of drains, total volume of tissue fluids upon drain removal, and complication rates.

Histologic analysis of zafirlukast's effect on capsule formation around silicone implants.

BACKGROUND: The most common complication experienced by patients who have undergone mammary implant surgery is capsular contracture. This matter concerns physicians and patients, but to date, there is no effective way to avoid this complication. Surgical intervention usually is required. In 2002, the use of zafirlukast, a leukotriene inhibitor (a drug used for asthma treatment), was reported for the treatment of capsular contracture, with good results. METHODS: For this study, 30 female Wistar rats were used. These animals received two silicone implants each: one with a smooth surface and one with a textured surface. All the animals received daily intraperitoneal injections for 90 days and were divided as follows: control group (C) receiving only saline solution, experimental group 1 (E-I) receiving 1.25 mg/kg/day of zafirlukast, and experimental group 2 (E-II) receiving 5 mg/kg/day of zafirlukast. Histologic analysis used hematoxilin and eosin to verify vessels, capsule thickness, and inflammatory cells. Immunoistochemical analysis with smooth muscle anti-actin antibody was used for myofibroblast verification. Picro-Sirius under polarized light was used for collagen analysis. RESULTS: Textured implant experimental groups presented smaller numbers of vessels, thinner capsules, lower collagen density, and smaller numbers of mastocytes and eosinophils than the control group. No significant differences were found in smooth surface implants, as compared with the control group. CONCLUSION: Zafirlukast reduced the occurrence of factors directly and indirectly connected with capsular contracture.