Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

OBJECTIVE: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects. METHODS: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD) with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO) and a history of stroke. Mean age was 33.8 years and mean weight was 55.4 kg. Mean diameter by transesophageal echocardiography and mean stretched ASD diameter were 11.33 ± 3.3mm, and 15.2 ± 3.8mm, respectively. The Qp/Qs ratio was 1.9 ± 0.3 in patients with ASD. RESULTS: Eleven occluders were placed because a patient with 2 holes needed 2 devices. It was necessary to retrieve and replace 4 devices in 3 patients. We observed immediate residual shunt (< 2mm) in 4 patients with ASD, and in those with patent foramen ovale total occlusion of the defect occurred. No complications were noted, and all patients were discharged on the following day. After 1 month, 2 patients with ASD experienced trivial residual shunts (1mm). In 1 patient, we observed mild prolapse in the proximal disk in the right atrium, without consequences. CONCLUSION: The Helex septal occluder was safe and effective for occluding small to moderate atrial septal defects. Because the implantation technique is demanding, it requires specific training of the operator. Even so, small technical failures may occur in the beginning of the learning curve, but they do not involve patient safety.

Electrophysiological Studies and Radiofrequency Ablations in Children and Adolescents with Arrhythmia

Background:Radiofrequency ablation is the standard non-pharmacological treatment for arrhythmias in pediatric patients. However, arrhythmias and their associated causes have particular features in this population.Objective:To analyze the epidemiological characteristics and findings of electrophysiological diagnostic studies and radiofrequency ablations in pediatric patients referred to the Electrophysiology Unit at Instituto de Cardiologia do Rio Grande do Sul, in order to characterize the particularities of this population.Methods:Cross-sectional study with 330 electrophysiological procedures performed in patients aged less than 20 years between June 1997 and August 2013.Results:In total, 330 procedures (9.6% of the overall procedures) were performed in patients aged less than 20 years (14.33 ± 3.25 years, age range 3 months to 19 years), 201 of which were males (60.9%). A total of 108 (32.7%) electrophysiological diagnostic studies were performed and of these, 48.1% showed abnormal findings. Overall, 219 radiofrequency ablations were performed (66.3%) with a success rate of 84.8%. The presence of an accessory pathway was the most prevalent finding, occurring in 158 cases (72.1%), followed by atrioventricular nodal reentrant tachycardia (16.8%), typical atrial flutter (3.1%) and extrasystoles originating from the right ventricular outflow tract (2.7%). Three patients developed complications during ablation (1.4%). Among congenital heart diseases, which occurred in 51 (15.4%) patients, atrial sept defect was the most frequent (27.4%), followed by ventricular sept defect (25.4%) and Ebstein's anomaly (17.6%).Conclusion:Electrophysiological study and radiofrequency ablation are effective tools for diagnosis and treatment of arrhythmias in the pediatric population.

Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices

Abstract Background: Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management. Methods: We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014. Results: Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation. Conclusion: Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions.

Ecologia da ictiofauna de um córrego de cabeceira da bacia do alto rio Paraná, Brasil

Ecological studies were conducted in the ichthyofauna of Cedro, a small headwater stream located in a degraded area of State of São Paulo, Brazil, situated in the upper Paraná River basin. These are the results of two non-consecutive years observations and collections in two biotopes of that stream: a pool and a rapid. The ecological characteristics studied change in space and time. The present richness of species is high (21 species), nine of which are constant, six accessory and six accidental. The diversity is low (0.69 to 2.38), and the numeric predominance, from one to three species, occurred in both biotopes. The most frequent species are Poecilia reticulata (Peters, 1859) (28.1%), Corydoras cf. aeneus (Gill, 1858) (20.3%) and Hypostomus cf. ancistroides (Ihering, 1911) (19.8%). The density ranges from 0.7 to 19.8 specimens/m³. The similarity index indicates high similarity between the ichthyofauna (45.0% to 95.0%) inside the same or contiguous biotopes. The evenness (0.46 to 1.0) is comparable to those found in similar studies carried out in other streams.

Histomorfologia do órgão acessório de perfuração de Thais haemastoma (Mollusca, Gastropoda)

Os representantes da família Thaididae são organismos predadores de outros moluscos, perfurando suas conchas pela ação alternada de secreção oriunda do "Accessory Boring Organ" (ABO) e por raspagem através da rádula. Nesta família, o ABO está localizado na porção ventral mediano-anterior do pé. Os animais examinados neste estudo foram coletados na praia do Futuro, Fortaleza, em seguida levados ao laboratório para fixação e posterior tratamento histológico rotineiro. A porção glandular do ABO de Thais haemastoma (Linnaeus, 1758) se encontra alojada em uma cavidade circundada pela musculatura do pé e apresentando um ducto excretório que a comunica com o meio externo. Esta cavidade é revestida por um epitélio cilíndrico simples separando a porção glandular deste órgão do músculo pedioso, sendo contínuo com o epitélio de revestimento do ducto excretório. Subjacente a este tecido foi visualizado um tecido conjuntivo frouxo. A região glandular do ABO da espécie apresenta um formato discoidal com superfície irregular devido à presença de reentrâncias em direção à porção central da glândula. O epitélio glandular pseudoestratificado com células cilíndricas e ciliadas reagiu negativamente aos testes histoquímicos. Abaixo do epitélio, foi observado um tecido conjuntivo frouxo de sustentação.

Cytochemical study of Rhodnius neglectus and Rhodnius prolixus salivary gland cells (Hemiptera, Triatominae)

Triatomines are hematophagous bugs of medical interest in South and Central America, where they may act as invertebrate hosts of the hemoflagellate protozoa Trypanosoma cruzi (the causative of Chagas’ disease) and Trypanosoma rangeli (Tejera, 1920). Triatomines of Rhodnius genus have salivary gland formed by two close and independent units: the principal and the accessory. This gland secretes saliva that abounds in substances that facilitate and permit feeding. Despite this importance, there are few reports on its cytochemistry. In purpose of amplifying this understanding, in this work it was investigated the nuclear structures (chromatin and nucleolar corpuscles) of salivary gland cells of Rhodnius neglectus (Lent, 1954) and Rhodnius prolixus (Stål, 1859). The salivary glands were removed from adult insects, fixed and submitted to different cytochemical methods: lacto-acetic orcein, silver ion impregnation, Feulgen reaction, Toluidine Blue, Variant method of critical electrolyte concentration and C-banding. The results evidenced predominance of binucleated cells, with bulky and polyploid nucleus, decondensed chromatin and a large nucleolar area. In addition, cytoplasmic metachromasy and a clear association between nucleolar and heterochromatic corpuscles were observed. Such characteristics were associated with intense synthesis activity to produce saliva. Besides, the heterochromatic corpuscles observed with C Banding permitted the differentiation of sexes and species.

A regulação do lobo anterior da hypophyse por um hormonio testicular, especialmente sob o ponto de vista morphologico

The authors summarize the results of former works, based on the technics of parabiosis. After parabiotic union of two infantile rats, normal + castrate, the normal fellow enters into precocious puberty in about 7 days (Kallas). In the case of pairs: castrated male + normal female, the implants of testicles, or injection of maceration or aqueous extracts of testis in the castrated fellow, prevents the induction of early puberty in the normal female. In the case: castrated female + normal female, no inhibiting effect is provoked by that treatment. There is therefore a testicular hormone that regulates the hypophysis. After castration, this gland manifests a hyper-function and shows histological alterations, the chief character of these being the appearing in the anterior lobe, of the so-called castration cells, probably originated from basophile cells. Implants or injections of testis material prevent those alterations. This is a useful test; the effect is controlled by estimating the castration cells in the microscopic field. The testicular hormone that regulates the anterior lobe is probably another one, quite different from that which regulates the accessory genitalia. On account of the facts and experiments, it may be assumed that this new hormone is elaborated by the germinal epithelium of the testicles.

Anatomy and histology of Embolyntha batesi MacLahlan, 1877 (Embiidina)

The Embioptera are rather generalized insects whose internal anatomy is simple and not subject to great modifications. For this reason these insects form an ideal group for elementary anatomical and histological studies (fig. 2). The digestive tract is a long, simple tube without convolutions or diverticulae from the buccal cavity to the rectum. The buccal structures are of the chewing type. The oesophagus and ingluvia are differentiated only by slight dilation of their walls. In nymphs and females the proventriculus is very distinct due to folds which flatten as the structure becomes packed with food. The enteron is the largest in such forms and in both sexes limited caudally by the Malpighian tubules. The proctodeus has six large rectal papillae. The nervous system is complete with only the fifth abdominal segment lacking a ganglion in the metathorax includes the ganglion of the first abdominal segment. The brain exhibits very clear structure in histological sections. The tracheal system includes two pairs of thoracic spiracles and eight abdominal pairs. Only th metathoracic spiracle has an air expiration function; all others serve for inspiration. Various structures in the spiracles protect the atrium. The circulatory system includes a long, simple dorsal vessel which extends forward from the ninth abdominal segment into the cranium. It opens anteriorly near the circumoesophageal connectives. The dorsal vessel has a pair of ostia and valves corresponding to each abdominal and thoracic segment. It lacks the diverticulae or folds commonly found in more highly evolved insects. The excretory system is represented by Malphighian tubules, pericardial cells, and fat-body. The number and disposition of Malpighian tubules is variable within the order. The pericardial cells are localized around the entire dorsal vessel up to the opening of the aorta in the head. The fat-bodies form compact layers in the dorsal and ventral regions of the body. In males they are more developed in the abdominal region. The mandibles, maxillae, and salivary glands are of a simple type with very few cytological modifications. Only the salivary glands which extend into the mesothoracic region show appreciable specialization. The reproductive system is bi-sixual and shows considerable sexual dimorphism. Males have five pair of testes with a metameric disposition, two distinct ducts, two epidymis, and the ejaculatory organs. The accessory glands vary in number and size and open in the anterior portion of the ejaculatory duct. The female reproductive organs are of the panoistic type. The system includes five pairs of ovarioles, two long paired oviducts a small, unpaired oviduct and the spermatheca which opens in the vagina. Reproduction usually involves a union of male and female gametes, and eggs are usually laid in clusters attached to a substrate.

Pseudohaliotrema paralonchuri sp.n. (Monogenoidea: Dactylogyridae), parasitic on Paralonchurus peruanus (Steindachner) (Teleostei: Sciaenidae) from the peruvian coast

Pseudohaliotrema paralonchuri sp. n., parasitic on the sciaenid fish Paralonchurus peruanus (Steindachner) from the Peruvian central coast, is described, illustrated and compared with related species of the genus. P. paralonchuri differs from other Pseudohaliotrema by the characteristics of the cirrus, accessory piece, anchors and bars. This is the first record of Pseudohaliotrema from the South American Pacific Ocean.

The reproductive capacity of Panstrongylus megistus (Hemiptera: Reduviidae) males treated with precocenes

Reproductive performance including mating, semen transfer, egg production and hatching rate were investigated in pairs of Panstrongylus megistus in wich the male was treated with either precocene II or ethoxyprecocene II, topically applied shortly after imaginal molt. Eighty percent of the males were not able to mate for a period as long as 40 days after treatment. Those males wich did mate (20%) produced small spermatophores; a few (10%) were unable to transfer spermatozoa to female, while the others (10%) exhibited reproductive performance similar to that of non-treated males. The cumulative effects of the precocene on the different stages of reproduction resulted in a drastic reduction of offspring production. The anti-allatal compound precocene seems to inhibit successful reproduction through a corpus allatum inactivation and subsequent lack of secretory activity of the male accessory glands.

A New Species of Kritskyia (Dactylogyridae, Ancyrocephalinae) Parasite of Urinary Bladder of Prochilodus lineatus (Prochilodontidae, Characiformes) from the Floodplain of the High Paraná River, Brazil

A new species of Kritskyia inhabits the urinary bladder of the "curimba", Prochilodus lineatus in the floodplain of the high Paraná river. The new species resembles others members of Kritskyia in the following features: haptor lacking anchors and with 14 hooks marginal, posterior male copulatory organ non articulated with the accessory piece and vagina a sclerotized tube. However, it differs from the known species mainly by the shape of the copulatory complex. This is the third endoparasitic monogenean species reported from freshwater Neotropical fish.

Polymorphism of the Human Immunodeficiency Virus Type 1 in Brazil: Genetic Characterization of the nef Gene and Implications for Vaccine Design

Most of the Brazilian HIV-1 samples have been characterized based on the structural genes (env, gag and pol) and no data concerning the variability of the accessory genes such as nef have been available so far. Considering the role of the nef on virus biology and the inclusion of this region in some HIV/AIDS vaccine products under testing, the purpose of this study was to document the genetic diversity of the nef gene in third-four HIV-1 Brazilian samples previously subtyped based on the env C2-V3 region. Although only few non-subtype B samples have already been analyzed so far, the cytotoxic Tlymphocyte epitopes encoded in this region were relatively conserved among the subtypes, with some amino acid signatures mainly in the subtype C samples. Considering the increasing of the non-B HIV-1 subtypes worldwide, in special the subtype C, more data should be generated concerning the genetic and antigenic variability of these subtypes, as well as the study of the impact of such polymorphism in HIV/AIDS vaccine design and testing.

A new species of Anoplodiscus (Monogenea: Anoplodiscidae) parasitic on Pagrus pagrus (Osteichthyes: Sparidae) from the coastal zone of the State of Rio de Janeiro, Brazil

A new species of Anoplodiscus (Monogenea, Anoplodiscidae), parasitic on gills of the red porgy, Pagrus pagrus, from the coastal zone of the State of Rio de Janeiro, Brazil, is described and illustrated. The new species can be differentiated from the other species of this genus by the shape of the accessory piece of the copulatory complex, and the length of the vagina. This is the first record of a species of Anoplodiscus in the Neotropical region.

Abnormal expression of CD54 in mixed reactions of mononuclear cells from hyper-IgE syndrome patients

Hyper-IgE syndrome (HIES) is a rare multisystem disorder characterized by increased susceptibility to infections associated with heterogeneous immunologic and non-immunologic abnormalities. Most patients consistently exhibit defective antigen-induced-T cell activation, that could be partly due to altered costimulation involving accessory molecules; however, the expression of these molecules has never been documented in HIES. Therefore, we investigated the expression of CD11a, CD28, CD40, CD54, CD80, CD86, and CD154 in peripheral blood mononuclear cells from six patients and six healthy controls by flow cytometry after autologous and mixed allogeneic reactions. Only the allogeneic stimuli induced significant proliferative responses and interleukin 2 and interferon gamma production in both groups. Most accessory molecules showed similar expression between patients and controls with the exception of CD54, being expressed at lower levels in HIES patients regardless of the type of stimulus used. Decreased expression of CD54 could partly explain the deficient T cell activation to specific recall antigens in HIES patients, and might be responsible for their higher susceptibility to infections with defined types of microorganisms.