Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination 'rectocele' should be changed to 'anorectocele'.

We present a new surgical stapling technique for treatment of rectocele when associated with internal mucosal prolapse or haemorrhoids using only one circular mechanical stapler. Eight female patients, mean age 53 years (range, 42-70), complaining of obstructed defecation with vaginal digitation because of rectocele associated with internal mucosal prolapse underwent transanal repair of rectocele and rectal mucosectomy using one circular stapler between April and July 2004. A running horizontal mattress suture was placed through the base of the rectocele including mucosa, submucosa and the muscle layer of the whole anterior anorectal junction wall. The prolapsed mucosa and the muscular layer were then excised with an electrical scapel. A continuous pursestring rectal mucosa suture was placed 0.5 cm before the previous anterior mucosa and muscle layers resected wound, including the anorectal junction wall which was kept separate from the posterior vaginal wall by a Babcock forceps. Posteriorly, the pursestring suture included only mucosal and submucosal layers. The stapled suture was positioned between normal anterior rectal wall and the anal canal, 0.5 cm above the pectinate line. The stapler was then closed, fired and withdrawn. One patient complained of a perianal hematoma on the seventh postoperative day, requiring surgical excision. Postoperative defecography showed correction of the rectocele and outlet obstruction disappeared in all patients. This novel combined manual-stapled technique for rectocele and rectal internal mucosal prolapse seems to be a safe procedure and the preliminary results are encouraging. Further investigations have to be performed to assess long-term outcome in a larger number of patients.

As informações sobre a disponibilidade de boro em solos do semi-árido brasileiro são escassas. Visando obter informações sobre o comportamento dos extratores de boro, foi desenvolvido um experimento em casa de vegetação, com 29 amostras superficiais (0-20 cm) de solos, coletadas em unidades de mapeamento representativas do Estado do Ceará, usando o girassol como planta indicadora. Foram usados vasos com 2,5 kg de solo e dois tratamentos de adubação com boro (0 e 1,5 mg kg-1) e três repetições por tratamento. Nos solos, foi determinado o boro solúvel, usado como índice de disponibilidade, com os extratores água quente, HCl 0,05 mol L-1 e manitol 0,05 mol L-1 + CaCl2 0,01 mol L-1. Realizaram-se dois cultivos, em seqüência e com duração de 40 dias cada. Após esse período, foi coletada a parte aérea das plantas, determinada a matéria seca, analisado o boro e calculadas as produções relativas de matéria seca e a absorção de boro pelas plantas de girassol. Os resultados mostraram a água quente como o melhor extrator do boro do solo, seguindo-se o HCl e o manitol. Os níveis críticos de boro disponível no solo para produções relativas de matéria seca superiores a 70 e 90%, respectivamente, foram de 0,24 e 0,45 mg kg-1, para a água quente; 0,28 e 0,56 mg kg-1, para o HCl, e 0,13 e 0,24 mg kg-1, para o manitol.

RESUMO