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PURPOSE: Peripheral nerve sheath tumors (PNSTs) are rare in pediatric patients, especially in the brachial plexus. Research on PNSTs is lacking. This article presents a retrospective cohort study of pediatric patients diagnosed and treated with PNSTs, specifically brachial plexus tumors. METHODS: All pediatric patients intervened in a single center between 2007 and 2023 with brachial plexus tumors were systemically analyzed. RESULTS: Eleven pediatric patients with 14 brachial plexus PNSTs were studied. The gender distribution was 64% female and 36% male, with an average age of 10.7 years. Ninety-one percent had a previous NF-1 diagnosis. Right brachial plexus presented a higher prevalence (64%). Pain, Tinel's sign, and stiffness masses were common during diagnosis. Motor deficits were noted in 43% of the patients. Surgery was indicated for symptoms, particularly pain and rapid growth, increasing malignancy risk. Due to suspected malignancy, an en bloc resection with safety margins was performed. Among the patients, 57% received a histopathological diagnosis of MPNST (malignant peripheral nerve sheath tumor). Treatment included radiotherapy and chemotherapy. Clinical follow-up was conducted for all cases, involving clinical and oncological evaluations for all MPNSTs. CONCLUSIONS: This article present a series of pediatric brachial plexus tumors, especially in NF-1, and emphasizes the importance of thorough evaluation for this group. Swift diagnosis is crucial in pediatrics, enabling successful surgery for small lesions with limited neurological symptoms, improving long-term outcomes. Prompt referral to specialized services is urged for suspected masses, irrespective of neurological symptoms. Benign tumor postsurgical progression shows better outcomes than MPNSTs, with complete resection as the primary goal. Needle-guided biopsy is not recommended.

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OBJECTIVE: Biopsies of peripheral nerve tumors (PNTs) are often used to plan an efficient treatment strategy. However, performing a biopsy is controversial when the mass is likely to be a benign PNT (BPNT). The aim of this study was to evaluate the side effects of biopsies in patients with potential PNTs. METHODS: A retrospective and cross-sectional study was conducted on 24 patients who underwent biopsy of a mass of unknown origin potentially originating from a peripheral nerve (MUOPON), performed in nonspecialty services, and who were later referred to the authors' service for resection of their lesion between January 2005 and December 2022. The patients were evaluated for pain score, presence of a motor or sensory deficit, biopsy diagnosis, and definitive histopathological postsurgical diagnosis. RESULTS: The location of the tumor was supraclavicular in 7 (29.2%) patients, in the axillary region in 3 (12.5%), in the upper limb in 7 (29.2%), and in the lower limb in 7 (29.2%). Twenty-one (87.5%) patients were evaluated by MRI before biopsy, and 3 (12.5%) underwent ultrasound. One patient did not have an examination before the procedure. Based on the biopsy findings, 12 (50%) analyses had an inconclusive histopathological result. The preexisting pain worsened, as measured 1 week after biopsy, in all patients and had remained unchanged at the first evaluation by the authors (median 3 months, range 2-4 months). In 1 case, the open biopsy had to be interrupted because the patient experienced excruciating pain. Four (16.7%) patients developed motor deficits. Subsequent surgery was hampered by scar formation and intratumoral hemorrhage in 5 (20.8%) patients. The initial diagnosis obtained by biopsy differed from the final histopathological diagnosis in all patients, of whom 21 (87.5%) had BPNTs, 2 (8.3%) malignant peripheral nerve sheath tumors, and 1 (4.2%) an ancient schwannoma. CONCLUSIONS: Biopsies of PNTs are controversial and may result in misdiagnosis, neuropathic pain, or neurological deficit due to axonal damage, and they may also hinder microsurgical resection when if performed when not indicated. Indications for biopsy of an MUOPON must be carefully considered, especially if BPNT is a possible diagnosis.

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The aim was to evaluate the productive performance and nutrient export of maize intercropped with drought-tolerant forage grasses. The experimental design was a randomized blocks in a 2x2x2+1 factorial scheme (two forage grasses species ­ Massai and Buffel; two forage sowing methods - in the furrow and broadcast; and two forage sowing times - anticipated and simultaneous; and monoculture maize as an additional control), with three replicates. The maize+forage intercropping promoted greater competition for resources, especially water, limiting N uptake, chlorophyll synthesis, and biomass production by maize under semiarid conditions. Early sowing gave forage plants a competitive advantage, favoring forage establishment before or immediately after the sowing of maize. Thus, the simultaneous sowing of forage grasses in a semiarid environment is a more appropriate option considering the importance of high levels of chlorophyll to ensure high photosynthetic activity in maize plants and greater capacity of biomass synthesis. Massai intercropped with maize exhibits a greaterpotential for biomass production than Buffel under semiarid conditions. Maize+Buffel result in highest macronutrient export by maize, while maize+Massai result in highest macronutrient exports by total forage biomass under a semiarid environment. The choice of the forage species and its sowing time in relation to maize are the main determinants of successful intercropping systems under semiarid conditions.(AU)

O objetivo foi avaliar o desempenho produtivo e a exportação de nutrientes do consórcio de milho com gramíneas forrageiras tolerantes ao estresse hídrico. O experimento foi delineado em blocos casualizados em esquema fatorial 2x2x2+1 (duas espécies de gramíneas forrageiras ­ Massai e Buffel; dois métodos de semeadura ­ no sulco e a lanço; e duas épocas de semeadura ­ antecipada e simultânea; e monocultivo de milho como um controle adicional), com três repetições. O consórcio milho+forragem promoveu maior competição por recursos, principalmente água, limitando a absorção de N, síntese de clorofila e produção de biomassa pelo milho para condições semiáridas. A semeadura precoce deu vantagem competitiva às plantas forrageiras, favorecendo seu estabelecimento antes ou imediatamente após a semeadura do milho. Assim, a semeadura simultânea de gramíneas forrageiras em ambiente semiárido é uma opção mais adequada, considerando a importância de garantir altos teores de clorofila e, consequentemente, alta atividade fotossintética nas plantas de milho para garantir a capacidade de síntese de biomassa.Massai consorciado com milho apresenta maior potencial para produção de biomassa do que Buffel em condições semiáridas.Milho+Buffel resulta em maior exportação de macronutrientes pelo milho, enquanto milho+Massai resulta em maior exportação de macronutrientes pela biomassa forrageira total em ambiente semiárido.A escolha da espécie forrageira e sua época de semeadura em relação ao milho são os principais determinantes do sucesso do consórcio no semiárido.(AU)

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BACKGROUND: Anterior sacral meningocele (ASM) is a defect in the closure of the neural tube. Patients can be asymptomatic or present with genitourinary, neurological, reproductive, or colorectal dysfunction. Magnetic resonance imaging (MRI) is the gold standard test because it can assess communication between the spinal subarachnoid space and the lesion and identify other abnormalities. Surgical correction is the definitive treatment because untreated cases have a mortality rate of more than 30%. OBSERVATIONS: A 24-year-old woman with Marfan syndrome presented with polyuria, recurrent urinary tract infections, and renal injury for 3 months along with a globose abdomen, with a palpable mass in the middle and lower third of the abdomen that was massive on percussion. MRI showed an ASM consisting of two cystic lesions measuring 15.4 × 14.3 × 15.8 and 6.7 × 6.1 × 5.9 cm, respectively, compressing the distal third of the right ureter and causing a hydroureteronephrosis. Drainage and ligature of the cystic lesion were performed. The urinary outcome was excellent, with full recovery after surgery. LESSONS: ASM should be suspected in all abdominal masses with progressive symptoms in the setting of Marfan syndrome. Computed tomography and MRI are important to investigate genitourinary anomalies or other types of dysraphism to guide the best surgical approach.

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BACKGROUND: Traumatic brachial plexus injuries are devastating lesions, and neurotization is an usually elected surgical therapy. The phrenic nerve has been harvested as a motor fibers donor in brachial plexus neurotization, showing great results in terms of motor reinnervation. Unfortunately, these interventions lack solid evidence regarding long-term safety and possible late respiratory function sequelae, raising crescent concerns after the COVID-19 pandemic onset and possibly resulting in reduced propensity to use this technique. The study of the distal anatomy of the phrenic nerves may lead to a better understanding of their branching patterns, and thus the proposition of surgical approaches that better preserve patient respiratory function. METHODS: Twenty-one phrenic nerves in 10 formalized cadavers were scrutinized. Prediaphragmatic branching patterns were inspected through analysis of the distance between the piercing site of the nerve at the diaphragm and the cardiac structures, number of divisions, and length from the point where the main trunk emits its branches to the diaphragm. RESULTS: The main trunk of the right phrenic nerve reaches the diaphragm near the inferior vena cava and branches into 3 major divisions. The left phrenic nerve reaches the diaphragm in variable locations near the heart, branching into 2-5 main trunks. Moreover, we noticed a specimen presenting 2 ipsilateral parallel phrenic nerves. CONCLUSIONS: The right phrenic nerve presented greater consistency concerning insertion site, terminal branching point distance to this muscle, and number of rami than the left phrenic nerve.

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The aim of this study was to assess the chemical characteristics of a continuous aerobic composting process with passive aeration of feed material from the production and slaughter of small ruminants at different moisture levels. The composting process was performed in a brick barn with solid residues (manure and carcass parts) from the slaughter of goats and sheep along with chopped dry elephant grass and tree trimmings. The treatments employed three moisture contents (30, 50, and 70% water) and four sample collections at timed intervals (0, 30, 60, and 120 days), with three repetitions. The variables evaluated were the chemical attributes of the generated compost. The compositing process increased the concentrations of the elements Ca, Mg, S, Cu, Fe, Mn, and Zn and reduced the pH, lignin, and lignin/nitrogen ratio. The levels of N, P, and B increased up to 111, 61, and 94 days, respectively, whereas no change in the K content occurred. At the end of the process at 120 days, the contents of N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn, and electrical conductivity were increased by 33.7, 6.3, 17.5, 16.3, 666, 22, 31.3, 49.7, 30.4, 29.4 and 16.1%, respectively. The pH and lignin values decreased by 8.4 and 27.2%, respectively.(AU)

O objetivo deste estudo foi avaliar as características químicas de um processo contínuo de compostagem aeróbia com aeração passiva com material de alimentação proveniente da produção e abate de pequenos ruminantes, realizado com diferentes níveis de umidade. O processo de compostagem foi realizado em celas de tijolos, com resíduos sólidos (esterco e partes de carcaça) do abate de cabras e ovelhas, juntamente com capim-elefante seco picado e aparas de árvores. Os tratamentos empregaram três teores de umidade nas pilhas (30, 50 e 70%) e intervalos de tempo (0, 30, 60 e 120 dias) de avaliação do material compostado, com três repetições. As variáveis avaliadas foram os atributos químicos do composto gerado. O processo de compostagem aumentou as concentrações dos elementos Ca, Mg, S, Cu, Fe, Mn e Zn e reduziu o pH, o teor de lignina e a razão lignina/nitrogênio. O N, P e B apresentaram maior teor com 111, 61 e 94 dias, respectivamente. O K não teve sua concentração alterada. O teor de água de 70% produziu os maiores teores de N e menor razão lignina/N. Ao final do processo de compostagem, em 120 dias, houve aumento dos teores de N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn e condutividade elétrica em 33,7; 6,3; 17,5; 16,3; 666; 22; 31,3; 49,7; 30,4: 29,4 e 16,1%, respectivamente. E houve decréscimo nos valores de pH e lignina em 8,4 e 27,2%, respectivamente.(AU)

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Neurofibromatosis type 1 (NF1) is a genetic syndrome which typically presents with neurological manifestations. Some of the patients may also present with vasculopathies, among which arterial aneurysms and stenosis are the most common. Deep vein thrombosis (DVT) has rarely been described, and, to the best of our knowledge, the present is the first report of DVT due to venous compression by a neurofibroma in the setting of NF1. This is the case of a 23-year-old male with NF1 who experienced DVT due to compression of the left posterior tibial veins by a large tumor arising from the tibial nerve. The DVT was acutely treated with enoxaparin and then with rivaroxaban. Two months after the diagnosis, Doppler ultrasonography showed partial recanalization and persistence of the DVT. The patient was then referred to neurosurgery for surgical resection of the tumor. There were no complications during the procedure, and the patient did not present postoperative neurological deficits. The final histopathological diagnosis was of a benign neurofibroma. After one year of follow-up with vascular surgery, the patient presented no more episodes of DVT. In case there is a tumor compressing the deep vessels of the leg and promoting DVT, surgical resection with microsurgical techniques may be curative.

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OBJECTIVE: Data concerning the surgical treatment of lumbosacral plexus tumors (LSPTs) is scarce. This study aims to present our experience with a series of 19 patients surgically treated for symptomatic LSPTs at our institution. METHODS: This is a retrospective study of 19 patients surgically treated for symptomatic LSPTs from 2011 to 2019. Clinical data were retrieved from medical records and consisted of age, gender, clinical presentation, location of the lesion, surgical approach, final histopathologic diagnosis, follow-up time, outcomes, and complications. RESULTS: Nineteen surgical procedures were conducted. Thirteen patients were female and six, male. The median age of patients was 45 years (range 20 to 63 years). No patients harbored genetic syndromes. Surgical treatment appears to be correlated to the reduction of pain in patients with peripheral nerve sheath tumors (PNSTs), as assessed by visual analog scale (VAS). Sixteen patients did not present with new-onset deficits during follow-up (84.2%), two of whom recovered from their preoperative deficit. Four patients presented with postoperative weakness. The histopathological diagnoses were 11 schwannomas, four neurofibromas, three metastases, and one lymphoma. CONCLUSIONS: LSPTs are rare. When surgical treatment is indicated, it usually requires multidisciplinary management. Surgery appears to be effective concerning the reduction of pain in PNSTs and may also recover neurological deficits. Iatrogenic neurological deficits are an evident risk, such that intraoperative multimodal monitoring should always be performed if available. In lesions involving the sacral plexus, we found it to be indispensable.

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PURPOSE: Motor deficits affecting anal sphincter control can severely impair quality of life. Peripheral nerve transfer has been proposed as an option to reestablish anal sphincter motor function. We assessed, in human cadavers, the anatomical feasibility of nerve transfer from a motor branch of the tibialis portion of the sciatic nerve to two distinct points on pudendal nerve (PN), through transgluteal access, as a potential approach to reestablish anal sphincter function. METHODS: We dissected 24 formalinized specimens of the gluteal region and posterior proximal third of the thigh. We characterized the motor fascicle (donor nerve) from the sciatic nerve to the long head of the biceps femoris muscle and the PN (recipient nerve), and measured nerve lengths required for direct coaptation from the donor nerve to the recipient in both the gluteal region (proximal) and perineal cavity (distal). RESULTS: We identified three anatomical variations of the donor nerve as well as three distinct branching patterns of the recipient nerve from the piriformis muscle to the pudendal canal region. Donor nerve lengths (proximal and distal) were satisfactory for direct coaptation in all cases. CONCLUSIONS: Transfer of a motor fascicle of the sciatic nerve to the PN is anatomically feasible without nerve grafts. Donor nerve length was sufficient and donor nerve functionally compatible (motor). Anatomical variations in the PN could also be accommodated.

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