Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism

Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis and a peripheral embolism. He had no history of thrombotic events. Transthoracic echocardiography showed a large, polypoid and mobile mass (4.0 × 1.2 cm) attached to the apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently underwent open heart surgery. The histological examination showed an older thrombus and a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming the primary APS diagnosis. The patient initiated treatment with oral anticoagulation (INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac mass recurrence on two-dimensional echocardiography was seen. Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular mass mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. Pre-operative investigations could not distinguish such a thrombus from a cardiac tumor and the diagnosis was made post-operatively

Investimentos privados, impactos ambientais e qualidade de vida num empreendimento mineral amazônico: o caso da mina de manganês de Serra do Navio (Amapá) Private investments, environmental impact, and the quality of life at a mining venture in the Amazon: the case of the Serra do Navio manganese mine in Amapá

O texto discute as conseqüências ambientais e socioeconômicas de um grande empreendimento de extração mineral na Amazônia brasileira. Entre 1957 e 1998, a Indústria e Comércio de Minérios S. A. (ICOMI) explorou manganês no Amapá, em Serra do Navio, uma das maiores minas desse minério no mundo. Foi o primeiro e o mais durável empreendimento mineral de grande escala e intensivo de capital na região amazônica brasileira. O texto apresenta um perfil biofísico e socioeconômico do Amapá, caracterizando-o como fronteira de expansão da sociedade nacional. Discute o volume da produção, as características da companhia mineradora, mostrando seu sucesso comercial, os principais impactos ambientais do empreendimento, especialmente o desmatamento, o status da qualidade de água e a recuperação ambiental da área minerada, concluindo que esses impactos foram localizados e moderados. Na conclusão, são apresentados os resultados de um exercício de mensuração dos níveis de bem-estar socioeconômico da população do Amapá entre 1953 e 1993: as melhoras foram sensíveis.<br>The text examines the environmental and socioeconomic consequences of a major mining venture in the Brazilian Amazon. From 1957 to 1998, Indústria e Comércio de Minérios S. A. (ICOMI) extracted ore from one of the world’s largest manganese mines, located in the Serra do Navio highlands region of the state of Amapá. ICOMI was the first and longest-running large-scale, capital-intensive mining operation in the Brazilian Amazon. Based on a biophysical and socioeconomic profile of Amapá, the region is characterized as a frontier for an expanding Brazilian society. After discussing the mining company’s characteristics, its production volume and commercial success, main environmental impacts (particularly deforestation), area water quality, and the environmental recovery of the mined area, it is concluded that impacts have been localized and moderate. Furthermore, measurements of the levels of socioeconomic well being in Amapá between 1953 and 1993 indicate significant improvements