ABSTRACT Soil quality, measured through its chemical, physical and microbiological attributes, changes as a result of anthropic sensations and becomes an important tool to assess environmental quality. The objective of this study was to determine and evaluate the Quality Index of an Ultisol in a long-term (17-yr) plots under different management systems in the Coastal Tablelands of Sergipe State, in Northeastern, Brazil. Main effects were conventional tillage (CT), no-tillage (NT), and minimum tillage (MT) distributed cultivated strips with corn as the main crop. Split-range treatments were randomly distributed and cultivated with cowpea beans (Vigna unguiculata), sunn hemp (Crotalaria juncea), pigeon pea (Cajanus cajan), and millet (Pennisetum glaucum). A forest soil was used as reference, compared to the soil samples of the cultivated area. The Soil Quality Index (SQI) for the 0-0.10 m layer was calculated by the additive method. There were changes in soil properties between the different management systems, and between the experimental soil and the reference area. The highest SQI was obtained from the forest area (67.1) followed by the NT treatment (65.5), MT (65.1) and CT treatment (61.0). The lowest SQI was observed in the CT treatment previously cultivated with pigeon pea (56.5). Among the evaluated soil functions, maintenance of homeostasis had the greatest influence on the SQI. The higher acidity of the forest soil helps to explain the origin of the limitations of the soil in the cultivated area that occupies the same type of soil, tolerated by the adoption of conservationist managements.

RESUMO A qualidade do solo, medida por meio de seus atributos químicos, físicos e microbiológicos, muda em função das interações antrópicas e torna-se uma importante ferramenta para avaliar a qualidade ambiental. O objetivo deste estudo foi determinar e avaliar o Índice de Qualidade de um Argissolo em parcelas de longo prazo (17 anos) sob diferentes sistemas de manejo nos Tabuleiros Costeiros do Estado de Sergipe, Nordeste do Brasil. Os principais efeitos foram plantio convencional (CC), cultivo minimo (CM) e plantio direto (MT) distribuídos em faixas cultivadas com milho como cultura principal. Os tratamentos fracionados foram distribuídos aleatoriamente e cultivados com feijão-caupi (Vigna unguiculata), crotalária (Crotalaria juncea), feijão guandu (Cajanus cajan) e milheto (Pennisetum glaucum). Um solo florestal foi utilizado como referência. O Índice de Qualidade do Solo (IQS) para a camada de 0-0,10 m foi calculado pelo método aditivo. Houve mudanças nas propriedades do solo entre os diferentes sistemas de manejo, e entre o solo do experimento e a área de referência. O maior IQS foi obtido da área de floresta (67,1) seguido do tratamento PD (65,5), CM (65,1) e tratamento CC (61,0). O menor IQS foi observado no tratamento CC previamente cultivado com feijão guandu (56,5). Dentre as funções avaliadas do solo, a manutenção da homeostase teve a maior influência no IQS. A maior acidez do solo florestal ajuda a explicar a origem das limitações do solo na área cultivada que ocupa o mesmo tipo de solo, exigindo a adoção de manejos conservacionistas.

ABSTRACT Objectives: To assess whether parental modeling, regarding the practice and/or encouragement of diets, can predict risk behaviors related to eating disorders (EDs) in children and adolescents. Methods: A systematic review of studies published until June 2022, available in indexed databases – such as PubMed, Virtual Health Library, SciELO and Cochrane Library, was carried out. Cross-sectional and longitudinal studies in Portuguese, Spanish and English were included and assessed for risk of bias according to the NewCastle – Ottawa Quality Assessment Scale. Results: Fourteen studies were considered in the review. Most of them are cross-sectional (71.4%), coming from the United States and European countries (57.1%), in addition to presenting a low risk of bias (85.7%). Most of the studies found associations between parental encouragement of diets (direct modeling) and risk behaviors in children and adolescents, such as the use of weight control methods, body dissatisfaction and food restriction. Few studies have related the father’s habit of dieting (indirect modeling) with these behaviors. Conclusions: Data support the idea that direct modeling, that is, verbal encouragement to use diets, can be very harmful, especially to individuals who are excessively concerned about weight and food. Future research is needed to assess the impact of parental eating practices and the development of possible actions to prevent weight-related problems.

RESUMO Objetivos: Avaliar se a modelagem paterna, quanto à prática e/ou ao incentivo a dietas, pode predizer comportamentos de risco relacionados a transtornos alimentares (TAs) em crianças e adolescentes. Métodos: Foi realizada uma revisão sistemática dos estudos publicados até junho de 2022, disponíveis nas bases de dados indexadas — como PubMed, Biblioteca Virtual de Saúde, SciELO e Cochrane Library. Estudos transversais e longitudinais em línguas portuguesa, espanhola e inglesa foram incluídos e avaliados quanto ao risco de viés de acordo com a NewCastle – Ottawa Quality Assessment Scale . Resultados: Quatorze estudos foram considerados na revisão. A maioria deles é transversal (71,4%), proveniente dos Estados Unidos e de países europeus (57,1%), além de apresentar baixo risco de viés (85,7%). Grande parte dos trabalhos encontrou associações entre o incentivo a dietas por parte dos pais (modelagem direta) e comportamentos de risco em crianças e adolescentes, como o uso de métodos de controle de peso, a insatisfação corporal e a restrição alimentar. Poucos estudos relacionaram o hábito de o pai fazer dieta (modelagem indireta) com esses comportamentos. Conclusões: Os dados embasam a ideia de que a modelagem direta, ou seja, o incentivo verbal ao uso de dietas, pode ser muito danosa, principalmente em indivíduos que têm preocupações excessivas com peso e alimentação. Futuras pesquisas são necessárias para avaliar o impacto das práticas alimentares parentais e o desenvolvimento de possíveis ações de prevenção a problemas relacionados ao peso.

Abstract The present study aimed to evaluate concentrations and forms of application of salicylic acid used for water stress mitigation on the gas exchange and growth of yellow passion fruit. The experimental design was arranged in randomized blocks in a 4 × 4 × 2 factorial scheme, with four concentrations of salicylic acid (SA) via foliar application (0.0, 0.7, 1.4, and 2.1 mM), four SA concentrations via fertigation (0.0, 0.7, 1.4, and 2.1 mM), and two irrigation depths estimated based on the actual evapotranspiration - ETr (50 and 100% of ETr), with three replications. Water stress negatively affected the physiology and growth of yellow passion fruit seedlings at 75 days after sowing (DAS). The application of salicylic acid, regardless of the form of application, attenuates the effects of water stress on gas exchange and growth of yellow passion fruit, with the best results obtained when applying a concentration of 1.30 mM via leaf or 0.90 mM via fertirrigation. The combination of foliar application of AS and fertigation contributed to improve photosynthetic and growth parameters under water conditions of 50 and 100% of ETr. The foliar application of AS presents superior responses to the application via fertigation. These results reinforce the hypothesis that the attenuation of water stress by salicylic acid is related to the maintenance of gas exchange, which depends on the concentration and form of application, and studies testing combinations throughout the crop cycle become promising for advances in knowledge from the action of this phytohormone on abiotic stress.

Resumo O presente estudo teve como objetivo avaliar as concentrações e formas de aplicação do ácido salicílico como mitigador do estresse hídrico sobre as trocas gasosas e parâmetros de crescimento do maracujazeiro amarelo. O delineamento experimental foi em blocos casualizados, em esquema fatorial 4 × 4 × 2, com tratamentos constituídos por quatro concentrações de ácido salicílico (SA) via aplicação foliar (0,0, 0,7, 1,4 e 2,1 mM), quatro concentrações de SA via fertirrigação (0,0, 0,7, 1,4 e 2,1 mM) e duas lâminas de irrigação estimadas com base na evapotranspiração real - ETr (50 e 100% da ETr), com três repetições. O estresse hídrico afetou negativamente a fisiologia e o crescimento das mudas de maracujazeiro amarelo aos 75 dias após o semeio (DAS). A aplicação de ácido salicílico, independente da forma de aplicação, atenua os efeitos do estresse hídrico nas trocas gasosas e crescimento do maracujazeiro amarelo, com os melhores resultados obtidos ao se aplicar a concentração de 1,30 mM via foliar ou 0,90 mM via fertirrigação. A combinação de aplicação de AS via foliar e fertirrigação contribuiu para melhorar os parâmetros fotossintéticos e de crescimento nas condições hídricas de 50 e 100% da ETr. A aplicação via foliar de AS apresenta respostas superiores a aplicação via fertirrigação. Esses resultados reforçam a hipótese de que a atenuação do estresse hídrico pelo ácido salicílico está relacionada a manutenção das trocas gasosas, a qual depende da concentração e forma de aplicada, sendo que estudos testando combinações ao longo do ciclo da cultura se torna promissores para avanços nos conhecimentos provenientes da atuação desse fitormônio sobre o estresse abiótico.

Resumo O silicato de sódio é a fonte complementar utilizada na reação de geopolimerização. Entretanto, esse reagente é produzido em alta temperatura ou em autoclave a alta pressão, o que gera muito impacto ambiental. Visando a produção de geopolímeros mais ecológicos, produziu-se um silicato de sódio alternativo (ASW) a partir da dissolução da sílica presente na cinza de casca de arroz (CCA). Foram preparados geopolímeros nas razões molares SiO2/Al2O3 de 3,0, 3,5 e 4,0 e com concentrações de NaOH de 8 e 10 M. Os corpos de prova foram submetidos a ensaios de resistência à compressão (7 e 28 dias), FTIR e DRX. O desempenho mecânico dos geopolímeros produzidos com ASW foi semelhante aos produzidos com silicato de sódio comercial. A análise do comportamento mecânico e dos espectros de infravermelho sugeriu que ocorreu maior dissolução da CCA com o aumento da relação molar SiO2/Al2O3 e da concentração do álcali.

Abstract Sodium silicate is a complementary source used in the geopolymerization reaction. However, this reagent is produced at high temperature or in an autoclave at high pressure, which generates a significant environmental impact. Aiming the production of greener geopolymers, an alternative sodium silicate (ASW) from the dissolution of silica present in rice husk ash (RHA) was produced. Geopolymers were prepared at SiO2/Al2O3 molar ratios of 3.0, 3.5, and 4.0, and concentrations of 8 and 10 M NaOH. The specimens were subjected to compressive strength (7 and 28 days), FTIR and XRD tests. The mechanical performance of ASW-produced geopolymers was similar to those made with commercial sodium silicate. Analysis of the mechanical behavior and infrared spectra suggested that there was a greater dissolution of RHA with increasing SiO2/Al2O3 molar ratio and alkali concentration.

Objective: To ascertain whether genetic variations in the serotonin transporter gene (5-HTTLPR 44-bp insertion/deletion polymorphism) influence an increase in depressive and anxiety symptoms in children and adolescents exposed to high levels of violence. Methods: Saliva samples were collected from a group of children who were working on the streets and from their siblings who did not work on the streets. DNA was extracted from the saliva samples and analyzed for 5-HTTLPR polymorphism genotypes. Results: One hundred and seventy-seven children between the ages of 7 and 14 years were analyzed (114 child workers and 63 siblings). Data on socioeconomic conditions, mental symptoms, and presence and severity of maltreatment and urban violence were collected using a sociodemographic inventory and clinical instruments. There was no positive correlation between the 5-HTTLPR polymorphism and presence of mental symptoms in our sample, although the children were exposed to high levels of abuse, neglect, and urban violence. Conclusions: Despite previous studies that associated adult psychiatric disorders with the 5-HTTLPR polymorphism and a history of childhood maltreatment, no such association was found in this sample of children at risk.

The aim of this work was the study on the separation of soybean oil/n-butane mixtures using a commercial hollow fiber ultrafiltration membrane (50 kDa). Oil/n-butane mixtures with mass ratios of 1:1 and 1:3 (wt), with the feed pressures of 5, 7 and 10 bar and transmembrane pressure of 1 bar were studied. Rejections of oil between 21 to 97.2%, oil fluxes between 0.04 and 0.98 kg/m² h and n-butane fluxes between 4 and 46 kg/m² h were observed, strongly influenced by the feed concentration. The increase in oil/n-butane mass ratio caused an increase in oil rejection and a decrease in the permeate flux of oil for most assays. The increase in the operating pressure caused an increase in oil flux and a consequent decrease in oil rejection. No degradation was observed in the membrane module during the operation with this non-aqueous feed stream, as confirmed by integrity tests.

In this work, the separation of refined soybean oil/n-hexane mixtures was investigated using a commercial hollow fiber ultrafiltration membrane 50 kDa. Three alcohols with different chain lengths were tested for the conditioning of the membrane; n-propyl alcohol showed the highest n-hexane permeate flux after conditioning. There was a decrease in the rejection and an increase in permeate flux over time. This behavior may be related to swelling and membrane plasticization by the oil. Rejections from 10.0 to 28.7% and total permeate fluxes from 12.2 to 65.3 kg/m²h were observed. An increase in the oil/n-hexane mass ratio and the pressure caused an increase in the rejection and permeate total flux for most assays. No degradation was observed in the membrane module.

There are numerous examples of the importance of small molecule migration in polymeric materials, such as in drying polymeric packing, controlled drug delivery, formation of films, and membrane separation, etc. The Chapman-Enskog kinetic theory of hard-sphere fluids with the Weeks-Chandler-Andersen effective hard-sphere diameter (Enskog-WCA) has been the most fruitful in diffusion studies of simple fluids and mixtures. In this work, the ability of the Enskog-WCA model to describe the temperature and concentration dependence of the mutual diffusion coefficient, D, for a polystyrene-toluene system was evaluated. Using experimental diffusion data, two polymer model approaches and three mixing rules for the effective hard-sphere diameter were tested. Some procedures tested resulted in models that are capable of correlating the experimental data with the refereed system well for a solvent mass fraction greater than 0.3.

The Vrentas/Duda proposal for the diffusion of polymer-solvent systems, which is based on the free-volume theory, was employed in correlating and predicting mutual diffusion coefficients in highly concentrated polymer solutions. It has been observed that the predictive version of the model is capable of qualitatively representing the experimental data, while the use of an adjustable parameter greatly improves the performance of the model. The systems studied were poly(vinyl) acetate-toluene and Neoprene-acetone, and a comparison between experimental data and calculated values from the Vrentas/Duda model is reported. A new experimental apparatus based on the sorption technique was built to provide reliable diffusivity data on the Neoprene-acetone system.

Foi pesquisada a presença de HTLV-l anticorpos no soro e no LCR de 150 pacientes com afeccões do sistema nervoso, particularmente mielopatias. Os pacientes foram considerados segundo três grupos, de acordo com a possível relação entre a doença e a presença de HTLV-l anticorpos: sem risco de relação (grupo controle); grupo de risco ocasional; grupo de risco possível. Este último abrange 56 pacientes com paraparesia ou paraplegia crural espástica de etiologia não esclarecida (PE). Foi utilizada para a pesquisa a técnica de aglutinação passiva de partículas para anti-ATLA anticorpo, sendo obtidos os seguintes resultados: não foram detectados HTLV-l anticorpos no grupo controle e foram detectados (soro e/ou LCR) em 16,5% dos pacientes do segundo grupo e em 55,4% daqueles do terceiro grupo. O quadro clínico dos pacientes com PE e HTLV-l anticorpos era compatível a paraparesia espática tropical (PET). Foi verificada diferença significativa quanto a dados do exame de LCR (citologia, concentração proteica e teor de globulinas gama) ao se compararem os pacientes com PET com HTLV-l anticorpos no LCR àqueles com PE em que tais anticorpos não foram detectados nem no soro e nem no LCR. Os resultados deste estudo confirmam a elevada incidência da PET no Brasil o ilustram a necessidade da pesquisa desses anticorpos também no LCR.

HTLV-l antibodies were investigated in serum and in CSF of 150 patients with neurologic disorders mainly myelopathies. The patients were considered into three groups according to the possible relationship of their disease to the presence of HTLV-l antibodies: no relationship risk (control group), occasional risk group, and possible risk group. In this latter are 56 patients with crural spastic paraparesis or paraplegia of unknown etiology (SP). HTLV-l antibodies were tested by the passive particle-agglutination method for anti-ATLA antibody detection. The search was negative in all patients of the control group, and positive (serum and/or CSF) in 16.5% of the patients from the second group and in 55.4% of the SP patients group. Clinical patterns in SP cases with HTLV-l antibodies were those of tropical spastic paraparesis (TSP). CSF patterns considered (cytology, protein content and gamma-globulins rate) were different between TSP group with HTLV-l antibodies in CSF and SP group with no HTLV-l antibodies detection either in serum or in CSF. The difference was significant. Results of this investigation confirm the high incidence of TSP in Brazil, and bring additional indication for searching HTLV-l antibodies in the CSF.

Foram estudados 357 exames por tomografia computadorizada do crânio (TC) de 100 pacientes com neurocisticercose, tratados com praziquantel (PZQ) entre 1979 e 1988. Foi utilizada nova classificação tomográfica, procurando estabelecer vincule entre as imagens observadas à TC e a evolução biológica dos cisticercos. Considerando-se como estimador o valor das medianas em meses após o tratamento com PZQ, foi possível concluir que: vesículas íntegras permanecem inalteradas em exames consecutivos por período de 11 meses; apresentam sinais radiológicos sugestivos de processo inflamatório, geralmente associados à degeneração de cisticercos, em período de 1S meses; estas vesículas em degenerarão podem ser detectadas durante 10,5 meses, desaparecem em 11 meses e evoluem para calcificações nodulares simples em 25 meses. De acordo com este critério, pode ser estimado período mínimo de 36 meses para o perfil de evolução de cisticercos no parênquima cerebral em pacientes tratados com PZQ.

Three hundred land fifty seven computed tomography (CT) from 100 different patients with neurocysticercosis (NC) were studied between 1979 and 1988. All patients were treated with praziquantel (PZQ). A new classification attempting to recognize the CT evolution profile in NC as well as assigning a possible link between CT findings and biological conditions of cysts is evaluated. It was possible to conclude that: intact cysts remain unchanged in consecutive CTs by 11 months and exhibit signs of degeneration in about 18 months after PZQ drug therapy; degenerating cysts can be detected by 10.5 months, disappear in 11 months and become nodular calcifications in about 25 months. Therefore, a time period of at least 36 months can be estimated for the complete evolution profile of cysts in the brain parenchyma.

Em 10 pacientes com neurocisticercose (NC) foi determinada a concentração de praziquantel (PZQ) no líquido cefalorraqueano (LCR), no soro não desproteinizado e no soro desproteinizado: antes do início do emprego da droga e nos dias primeiro, sétimo e 21º de administração oral da droga (50mg/kg/dia durante 21 dias). As amostras de LCR e de sangue foram colhidas três horas após a administração da dose diária nos dias 1 e 21 e de duas a 6 horas após no dia 7; a dose total diária foi repartida em três porções semelhantes de 1/3 cada, com intervalo de 4 horas entre cada tomada, exceto nos 5 últimos casos que apenas no dia 21 receberam a dose total diária em uma só tomada. Os resultados mostraram haver dispersão das concentrações séricas e que estas são semelhantes às observadas em pessoas normais, fato já registrado na literatura. Há correlação entre os níveis de PZQ no LCR e no soro, sendo estes próximos àqueles observados no soro desproteinizado, isto é, próximo à fração sérica livre. O tratamento estatístico dos resultados permite considerar que: as concentrações de PZQ no LCR e no soro desproteinizado estão em equilíbrio, do ponto de vista farmacodinâmico, desde o primeiro dia; este equilíbrio persiste até o 21º dia, conquanto em níveis diferentes dos registrados no sétimo dia; no dia 21º os teores de PZQ no LCR retornam a valores semelhantes aos registrados para o primeiro dia, sugerindo haver sido reduzida a níveis não significativos a participação de elementos de interação com a droga. Contudo, fatores que influenciam na concentração de PZQ no LCR, como aqueles ligados à absorção da droga, sua metabolização no fígado e a sua passagem através da barreira hêmato-encefálica, que pode estar alterada pela doença, devem ser levados em conta e permitem recomendar o estabelecimento de dose individual para cada paciente mediante monitorização da concentração real alcançada no soro e/ou no LCR.

In 10 patients with neurocysticercosis (NC), an assessment was made of the praziquantel (PZQ) concentration in the cerebrospinal fluid (CSF), in non-deproteinized serum and in protein-free serum: before administration of the drug and the 1st., 7th. and 21st. days of oral administration (50mg/kg/day during 21 days). Samples of CSF and blood were collected three hours after the last administration of the daily total dosage, on the 1st. and 21st days; and from 2 to 6 hours after drug administration on the 7th. day. The total daily dosage was distributed into three equal parts of 1/3 each, with a 4 hours' interval between intakes, except in the last 5 cases, who on the 21st. day only were given the total daily dosage on a single administration. Results have shown dispersion in serum concentrations, which are similar to those seen in normal subjects as recorded in literature. There is a correlation between PZQ levels in the CSF and in the serum, the latter being very close to those found in protein-free serum fraction. The statistical treatment of results allowed the following considerations: PZQ concentrations in the CSF and in the protein free serum are in balance from the pharmacodynamic standpoint on the first day; this balance is maintained up to the 21st. day although at different levels from those seen on the 7th. day; on the 21st. day PZQ contents in CSF goes back to its similar values as recorded on the 1st. day, and this suggests that the participation of drug interaction factors has been reduced to non-significant levels. However, several factors can influence PZQ concentration in CSF, as absorption rate, liver first-pass effect and blood-brain barrier changes, and individual dose should be established for each patient based on drug concentration monitoring in the serum and/or in the CSF.

Foram estudadas amostras de LCR e soro de 10 pacientes com neurocisticercose submetidos a tratamento com praziquantel visando a comparação de reações imunológicas. As reações estudadas foram ELISA-G, ELISA-M, imunofluorescência-G, imunofluorescência-M e fixação do complemento. As alterações e a variabilidade verificadas nesta série comprovam a natureza dos fenômenos neuroimunológicos descritos na afecção. Fenômenos da fase aguda foram verificados pelas reações ELISA-M e RIF-M em 6 casos pelo estudo do LCR e em apenas um caso pelo estudo do soro. Maior sensibilidade tanto para o diagnóstico como para o acompanhamento evolutivo foi observado para a reação ELISA-G quando comparada às demais reações imunológicas, tanto no LCR como no soro. É salientada a importância da realização sistematizada das várias reações imunológicas em pacientes com neurocisticercose.

Cerebrospinal fluid (CSF) and serum samples of 10 patients with neurocysticercosis under treatment by praziquantel were studied in four occasions: before treatment (day 0) and during treatment on three ocasions (days 1, 7 and 21). The immunological reaction analyzed were: ELISA-G and ELISA-M; immunofluorescence-G and immunofluorescence-M; complement fixation. The changes and the variability of results observed through these reactions in this study bring new data that confirm neuroimmunological findings already described in the disease. Acute phase response was found in CSF in 6 cases and only in one case in serum by ELISA-M and immunofluorescence-M. ELISA-G in CSF and serum showed a better sensitivity than the other reactions for diagnosis and for follow-up. Emphasis is given to the importance of the simultaneous realization of several immunological reactions in CSF and serum in patients with neurocysticercosis.

Foram estudadas as alterações eletrofisiológicas em 135 pacientes com síndrome do canal carpeano, num total de 270 mãos. As medidas das velocidades de condução sensitiva foram as alterações mais freqüentes, seguidas das alterações de condução motora e eletromiográficas. A técnica da medida de condução sensitiva estimulando a palma da mão e captando o potencial evocado acima do punho mostrou ser a mais sensível para o diagnóstico precoce da SCC.

One hundred thirty five patients with carpal tunnel syndrome were studied trough electrophysiological techniques. Nerve sensory conductions, motor conductions and electromyography were performed in all patients and the results discussed. The authors call the attention for the technic of sensory conduction stimulating palma and picking up the potentials on the wrist as the most sensitive technic for the early detection of carpal tunnel syndrome.

Registro de caso de mucormicose órbito-rino-cerebral em paciente diabético e em cetoacidose, com quadro clínico característico e que apresentou boa evolução graças ao tratamento iniciado precocemente. É feito um resumo dos principais registros da literatura a respeito da patologia.

The case of a 15 years old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two month after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with available literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results ootaineü with the proposed managment are stressed.