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Functional chronic constipation is a common symptom in daily clinical practice. Although the definition of constipation may be variable, there is usually agreement that (at least for research purposes) the definition given by the Rome Committee are useful. However, some blind spots or hidden angles remain, even in the more thorough classifications; among these, there is painful constipation, a poorly defined yet clinically encountered entity. The present article reviews the current knowledge about painful constipation, trying to put together the scarce data available, and to frame it in the more general context of chronic constipation.

Functional chronic constipation is a common symptom in daily clinical practice. Although the definition of constipation may be variable, there is usually agreement that (at least for research purposes) the definition given by the Rome Committee are useful. However, some blind spots or hidden angles remain, even in the more thorough classifications; among these, there is painful constipation, a poorly defined yet clinically encountered entity. The present article reviews the current knowledge about painful constipation, trying to put together the scarce data available, and to frame it in the more general context of chronic constipation.

Objetivou-se avaliar dietas suplementadas com diferentes níveis de complexo mineral e vitamínico, sobre os parâmetros produtivos, endimento de carcaça, índices somáticos e hematológicos de alevinos de tilápia-do-Nilo. Foram utilizados 540 alevinos de tilápia-do-Nilo com peso médio de 0,91 ± 0,07 g, distribuídos ao acaso em 18 tanques-rede de 1 m³. O período experimental teve duração de 116 dias, nos quais os peixes foram alimentados duas vezes ao dia com dietas suplementadas com diferentes níveis de complexo mineral e vitamínico (0; 0,25; 0,50;1,0; 2,0 e 4,0%). Foi observado efeito linear (P0,05) o rendimento da carcaça, índice hepatossomático e sobrevivência dos peixes. Os parâmetros hematológicos avaliados (hemoglobina, hematócrito, hemoglobina corpuscular média e volume corpuscular médio) foram superiores (P

ABSTRACT To evaluate the fungal diversity in the Pirarungaua stream reopened after remaining channeled about 40 years in the Botanical Garden of São Paulo, Brazil, two experiments in the cold and dry season and two in the hot and rainy season were performed. Leaves of Tibouchina pulchra Cogn and mixed leaf litter were confined in nylon litter bags, submerged and collected monthly, together with free leaf litter samples. Some abiotic factors were measured in the water. The leaves were fragmented, incubated in sterile water at 22 ºC and microscopically analyzed. We identified 33 conidial fungal taxa, among which, 23 are new to this area. Comparing seasons, the similarity of the mycota of confined T. pulchra leaves corresponded to 39% and to 56% regarding the confined mixed leaf litter. Similarities of 48-50% occurred between the mycota of confined and free leaf litter samples. Confined leaves showed a tendency to support higher numbers of species, whereas some rare fungi like Ulocoryphus mastigophorus Michaelides L. Hunter & W.B Kendr were more frequent in free leaf litter. Based on the results, it is recommended to monitor the limnological conditions of the stream and to promote awareness among the local population and visitors about the importance of a water body, even artificial, for the establishment of microclimatic features, and for the biodiversity of fungi.

Aims: To compare the efficacy and feasibility of the sciatic nerve block performed using either a posterior or a lateral approach to the popliteal fossa, taking into consideration patient comfort during puncture and postoperative analgesia., Patients and Methods: Sixty patients scheduled for foot surgery were randomly assigned to 2 groups: a posterior approach was used in performing the sciatic nerve block in 1 group (n = 30) and a lateral approach was in the other group (n = 30). The local anesthetic employed was mepivacaine 1%., Results: Duration of sensory block was used significantly longer with the lateral approach (5.4 hours, range 3.3-8 hours) than with the posterior approach (4.4 hours, range 1.5-7 hours) (P < 0.001). Time to onset of the block was significantly shorter with the lateral approach (10 minutes, range 5-25 minutes) than with the posterior approach (17 minutes, range 4-45 minutes) (P < 0.01). Quality of the blockade was similar with both approaches., Conclusions: The lateral approach to the block of the sciatic nerve in the popliteal fossa provides analgesia comparable to that obtained with the posterior approach, with a faster onset and longer postoperative duration.

We review the use of urapidil to manage hypertension in two patients undergoing adrenalectomy for pheochromocytoma and aldosterone producing adenoma. Bolus administration (25 mg/i.v.) of urapidil provided good control of blood pressure during surgical manipulation of the tumor, although continuous perfusion of the drug was required by one patient before complete excision was achieved. No changes in heart rate or sudden decrease in blood pressure were observed. We believe that urapidil may be useful for treating hypertension during tumor adrenalectomy.