Mitral valve repair with a malleable bovine pericardium ring

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4±17.2) years, were studied over a 16-month period, with 100% follow-up. In 23 (72%) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2%) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions). Of four (12%) of the remaining patients, 6% had moderate and 6% had seigre insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%), II (32%), and III (3%), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.

Multiple recurrences of cardiac myxomas with acute tumoral pulmonary embolism

We report the case of a 42-year-old female with a second recurrence of cardiac myxoma. Her first diagnosis was at the age of 24 years, when cardiac tumors were withdrawn from her right ventricle and left atrium. Her first recurrence was at the age of 36 years, when tumors were removed from the left and right atria, and the right ventricle. Six years later, the patient was admitted to the Hospital das Clínicas de Porto Alegre complaining of sudden dyspnea, dry cough, and pain in the right hypochondrium, which bore no relation to breathing. The transesophageal echocardiography showed a small tumor in the interatrial septum, close to the superior vena cava, and 2 larger tumors in the right ventricle, 1 close to the outflow tract and the other almost completely obstructing the right branch of the pulmonary artery. The patient was referred to surgery, in which myxomas were removed from the right atrium and ventricle with extension to the right pulmonary artery. The postoperative period was uneventful.

Myocardial Revascularization Surgery with Regional Anesthesia Without an Endotracheal Tube in Conscious Patients

OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS) performed on patients who were totally awake and without an endotracheal tube.METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administratios of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed.RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours.CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary.

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

Effects of Ischemic Postconditioning on the Hemodynamic Parameters and Heart Nitric Oxide Levels of Hypothyroid Rats

Background: Ischemic postconditioning (IPost) is a method of protecting the heart against ischemia-reperfusion (IR) injury. However, the effectiveness of IPost in cases of ischemic heart disease accompanied by co-morbidities such as hypothyroidism remains unclear. Objective: The aim of this study was to determine the effect of IPost on myocardial IR injury in hypothyroid male rats. Methods: Propylthiouracil in drinking water (500 mg/L) was administered to male rats for 21 days to induce hypothyroidism. The hearts from control and hypothyroid rats were perfused in a Langendorff apparatus and exposed to 30 min of global ischemia, followed by 120 min of reperfusion. IPost was induced immediately following ischemia. Results: Hypothyroidism and IPost significantly improved the left ventricular developed pressure (LVDP) and peak rates of positive and negative changes in left ventricular pressure (±dp/dt) during reperfusion in control rats (p < 0.05). However, IPost had no add-on effect on the recovery of LVDP and ±dp/dt in hypothyroid rats. Furthermore, hypothyroidism significantly decreased the basal NO metabolite (NOx) levels of the serum (72.5 ± 4.2 vs. 102.8 ± 3.7 μmol/L; p < 0.05) and heart (7.9 ± 1.6 vs. 18.8 ± 3.2 μmol/L; p < 0.05). Heart NOx concentration in the hypothyroid groups did not change after IR and IPost, whereas these were significantly (p < 0.05) higher and lower after IR and IPost, respectively, in the control groups. Conclusion: Hypothyroidism protects the heart from IR injury, which may be due to a decrease in basal nitric oxide (NO) levels in the serum and heart and a decrease in NO after IR. IPost did not decrease the NO level and did not provide further cardioprotection in the hypothyroid group.

Heart Rate and Systolic Blood Pressure Variability on Recently Diagnosed Diabetics

Background:Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction.Objective:To determine the variability of heart rate (HR) and systolic blood pressure (SBP) in recently diagnosed diabetic patients.Methods:The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains.Results:In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and number of pairs of successive NNs that differ by more than 50 ms (pNN50). In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS) decreased in patients with early diabetes compared with healthy subjects during the standing maneuver.Conclusions:There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity.

Sex-Specific Equations to Estimate Maximum Oxygen Uptake in Cycle Ergometry

AbstractBackground:Aerobic fitness, assessed by measuring VO2max in maximum cardiopulmonary exercise testing (CPX) or by estimating VO2max through the use of equations in exercise testing, is a predictor of mortality. However, the error resulting from this estimate in a given individual can be high, affecting clinical decisions.Objective:To determine the error of estimate of VO2max in cycle ergometry in a population attending clinical exercise testing laboratories, and to propose sex-specific equations to minimize that error.Methods:This study assessed 1715 adults (18 to 91 years, 68% men) undertaking maximum CPX in a lower limbs cycle ergometer (LLCE) with ramp protocol. The percentage error (E%) between measured VO2max and that estimated from the modified ACSM equation (Lang et al. MSSE, 1992) was calculated. Then, estimation equations were developed: 1) for all the population tested (C-GENERAL); and 2) separately by sex (C-MEN and C-WOMEN).Results:Measured VO2max was higher in men than in WOMEN: -29.4 ± 10.5 and 24.2 ± 9.2 mL.(kg.min)-1 (p < 0.01). The equations for estimating VO2max [in mL.(kg.min)-1] were: C-GENERAL = [final workload (W)/body weight (kg)] x 10.483 + 7; C-MEN = [final workload (W)/body weight (kg)] x 10.791 + 7; and C-WOMEN = [final workload (W)/body weight (kg)] x 9.820 + 7. The E% for MEN was: -3.4 ± 13.4% (modified ACSM); 1.2 ± 13.2% (C-GENERAL); and -0.9 ± 13.4% (C-MEN) (p < 0.01). For WOMEN: -14.7 ± 17.4% (modified ACSM); -6.3 ± 16.5% (C-GENERAL); and -1.7 ± 16.2% (C-WOMEN) (p < 0.01).Conclusion:The error of estimate of VO2max by use of sex-specific equations was reduced, but not eliminated, in exercise tests on LLCE.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

A new species of Stratiodrilus (Polychaeta, Histriobdellidae) from freshwater crayfishes of southern Brazil

A new species of polychaete, Stratiodrilus vilae, epizoic on Parastacus brasiliensis (von Martens, 1869) and P. defossus Faxon, 1898, is described from the State of Rio Grande do Sul, southern Brazil. The new species has one pair of long, anal, conical ventral lobes, one on each side of the anus, claspers in the males, and one pair of tubercles in each of the posterior locomotor appendages; and the jaw apparatus not reaching the limit between the head and the first segment.

Morphological characterization and sex-related differences of the mandible of the armadillos Chaetophractus vellerosus and Zaedyus pichiy (Xenarthra, Dasypodidae), with consideration of dietary aspects

The morphological characteristics of the mandible of adult Chaetophractus vellerosus (Gray, 1865) and Zaedyus pichiy (Desmarest, 1804) were studied to establish its generalized design and to identify inter- and intra- (sexual) specific differences. Morphological descriptions were complemented with the application of univariate and multivariate (analysis of correlation matrices, PCA, discriminant analysis) techniques. The mandible of both species is very similar, and is characterized by elevated condyle, well developed angular process, distinct coronoid process, tooth row which extends to the rear end of the angle between body and ramus, and unfused but firm symphysis. Although both armadillos are omnivorous, a more slender configuration of the jaw in Z. pichiy could be indicative of a better adaptation of its masticatory apparatus to insectivory. The PCA showed an almost total segregation of both species on PC1 (47.7% of the total variance), with C. vellerosus being associated to mandibles taller and with wider body and ramus. Zaedyus pichiy was characterized by heavy loadings of length parameters on PC2 (22.6% of the variance). A small degree of sexual dimorphism was found, with size-based differences in C. vellerosus (larger mandibles in females) and shape-based differences in Z. pichiy (taller mandibles in males, longer ones in females). Correlations between variables were higher in males of both species, indicating a more stable shape of the mandible than in females. The selected parameters to discriminate sexes were the body length of the mandible in C. vellerosus (correct classification: ca. 86% in males, 81% in females), and the height of the mandible at the level of the last tooth in Z. pichiy (near 85% of right assignment in both sexes). The inclusion of a new variable (body length) in the latter species improved the classification of the females to 100%. Teeth are typically 10 in C. vellerosus and 9 in Z. pichiy, but aberrancies in this basic number, such as unilateral or bilateral extra or fewer teeth, are common.

Osteological alterations in the tucuxi Sotalia fluviatilis (cetacea, delphinidae)

We present a description of osteological alterations observed in the tucuxi, Sotalia fluviatilis (Gervais, 1853) from a sample of 43 specimens. Fractures were the most frequent alterations in the sample (16%), occurring in various regions of the skeleton such as the ribs, hyoid apparatus, transverse and neural processes of vertebrae and scapula. We observed three individuals with ankylosis between the cervical vertebrae and two individuals with morphological changes (cranio-caudally elongated hemal arch and flattened cranial margin of the scapula). The only observed pathology was a case of osteomyelitis in the left dentary, which caused the loss of teeth, deformation of the associated alveoli and the formation of a medial fistula (lingual) for drainage of purulent material. This represents the first record of osteomyelitis in S. fluviatilis.

Um chronographo de construção simples, permittindo registrar intervallos de tempo de 1 a 60 segundos

Descriptive memorial of a chronograph made from a common chronoscop (Eastman Timer). The chronoscop has been modified in order to permit to adjust distinct cog-wheels, everyone in its turn, to the axis of the seconds hand. Each of these cog-wheels holds a definite number of teeth accordingly with the time interval ones desire to record. A wheel with 20 teeth, for instance, is available for recording time in periods of each three seconds, another wheel with 6 teeth, will reckon time in intervals of 10 seconds and so on. These wheels may be interchanged most easily, which enables, with the same apparatus, to have at hand a time recorder for any time interval between one and sixty seconds. To register the time the apparatus is connected with a dry cell. A wire is attached to a binding post on the metal case of the apparatus, another wire being connected with an isolated binding post placed in front of the cog-wheel and fastened to a platinum point allowing open or shut the circuit, every time one of the cogs of the wheel comes into contact with this platinum point. A signal magnet is placed also in the circuit for writing the time intervals on the revolving drum.

Reticulo-endotheliomatose maligna

A spindle-cell sarcoma (fig. 5) apparently originating from the dura (fig. 4) was found at the autopsy of a male, mulato, 17 years of age. The bones of the skull (occipital and both parietals) were penetrated and destroyed (fig. 1 and 2). The nervous tissue was not penetrated, the only change in the brain being a depressed area where the tumor was included. Metastatic nodules were found in the liver (fig. 3),hepatic lymphnodes (fig. 14), spleen (fig. 12) and suprarenal bodies (fig. 15). The structure, however, in all those different locations was that of a typical endothelioma (figs. 8, 11 and 13). The cells are of large and moderate size, of polyhedral form, with vesicular nuclei, diminutive nucleoli and clear cytoplasm. (Figs. 6 and 8). They are arranged about a central lumen which represents a rudimentary vessel (figs. 9 and 13). Other areas are composed of cells without concentric arrangement (figs. 4 and 10). In small areas, the colums of liver cells are marginated in one side by typical sinusoids, while in the other side tumor cells arranged about a narrow lumen are seen suggesting a pathological (neoplastic) sinusoid (figs. 7 and 9). The case is considered as a multiple diffuse endothelioma. The origin of the tumor is referred to the reticulo-endothelial apparatus of the liver, the spleen, the suprarenal bodies and the lymph nodes, the structure being rather uniform in those organs. In the dura, the endothelioma reproduces the structure and presents the general character of a fibroblastic sarcoma; in some places, however, the structure of endothelioma could be found (fig.6). It corresponds to the reticulo-endotheliomatosis maligna according to Puhr's grouping of progressive changes in the reticulo-endothelial apparatus which is a follows: 1. HYPERPLASTIC - 1. Mnnocytic leukemia. 2. a) Aleukemic reticulosis (Goldschmid and Isaac). b) Idiopathic sarcoma of skin (Kaposi). c) Cutaneous sarcoid (Spiegler). 3. Secretory reticulosis. a) Gaucher's disease. b) Generalized xanthomatosis. c) Spleno-hepatomegaly with lipoidic cells (Pick). II. BLASTOMATOSUS OR NEOPLASTIC - 1. Benign - a) Circumscribed tumors. a) Epulis sarcomatosa; b) Benign giant-cells sarcoma of the bone - marrow of long bones. b) Generalized brown tumors of osteitis fibrosa. 2. Malignant - a) Circumscribed haemangio - endothelioma (reticulo- endothelioma (maligum). of {liver, spleen, bone-marrow. b) Generalized haemangio-endotheliomatosis (reticulo-endotheliomatosis maligna) (Grabowski).

Corythaica cyathicollis (Costa, 1864), aspectos sistemáticos, biológicos e econômicos (Hemiptera, Tingidae)

The present work deals with the systematic, biological and economic problems related to Corythaica cyathicollis (Costa, 1864) (Hemip., Tingidae). In the first part are presented the generic characteristics of Corythaica and is discussed the status of the specific name. The validity of C. cyathicollis, as stated by DRAKE and his collaborators, was denied by MONTE in his last works, he considered the species as C. passiflorae. Even in the modern literature no agreement has been achieved and three names are still used (cyathicollis, passiflorae and planaris) to designate the same insect. In order to resolve definitively this problem, a Neotype is designed to fill the place of the missing type of C. cyathicollis. Also in the first parte is discussed the taxonomic value of both male and female genitalia. The whole male copulator apparatus is studied and are illustrated the genital capsules of 8 species of this genus. Special mention is made of the shape of the basal plates and the proportions of the segmental membrana. The female genitalia is studied based upon the work of FELDMAN & BAILEY (1952). In the second part the biological cycle of C. cyathicollis is carefully studied. Descriptions of the egg are done and the ways of oviposition. The number of eggs laid by the female was observed to be about 350, during a period of more than 45 days. The eclosion of the neanide I is illustrated in some of its phases and the 5 larval instars are described and illustrated. Ending this part are included the lists of parasites and predators observed as well as the plant hosts. The actual geographical distribution is presented, based chiefly on HURD (1945). The economic problems concerning this species are reported in the third part of the work, and the ways of control are discussed. An experiment was carried out involving 4 insecticides: Malathion and Parathion, commonly used against this "lace bug"; Toxaphene and Dimethoate (American Cyanamid 12.880), the last one is an insecticide recently introduced in Brazil and was not previously used for these purposes, but gave the best results and it is quite able to control these insects even on crops showing highly developed infestations.

Terceira contribuicäo ao conhecimento do gênero Archytas Jaennicke, 1867: (Diptera, Tachinidae)

Twelve species of the genus Archytas Jennicke, 1867, eight of which described as new are studied and figured in detail. Definitions of the species are based mainly on characters of male genitalia. The male genital characters are the most significant for separation of the species and most demonstrative of their affinities. By examining a long series of species of this genus we came to the conclusion that the presence of one pair of median marginal bristles on the third abdominal tergite seems to be characteristic of the genus. This caracter apparently so important, is not however considered fundamental. The most significant example is found in Archytas lenkoi sp. n. and Archytas vexor Curran, 1928. In A. lenkoi we can find one or two pairs or thay may, less frquently, be absent. In A. vexor these bristles are lacking. The shape of the male copulatory apparatus of Jurinia nitidiventris Curran, 1928 refered to by CURRAN in his "Revision of Archytas", is not characteristic of any species of the group and so, is not considered in this paper. To help in the identification, the species studied here are divided into groups. The analis group" includes: A. apicifer (Walker, 1894), A. californiae (Walker, 1856), A. nivalis Curran, 1928, a. giacomellii (Blanchard, 1941), A. basifulvus (Walker, 1849), A. incasanus Townsend, 1912 and A. cirphis Curran, 1927. The identification of members of these group is extremely difficult owing both to their similarity in colour pattern and to their variability. They all have black testaceous or dark brown abdomen, the last segment pale or brownish pollinose; second segment without bristles; third with a pair of strong marginals, fourth and fifth with two rows of discals on apical third. The final determination often rests upon the structure of the male copulatory apparatus. Fortunately in this group, many of the forcipes superiores and palpi genitalium are strikingly different from one another. The "zikani group" includes: A. zikani sp. n., A seabrai sp. n., A. duckei sp. n. and A. vernalis Curran, 1928. This group may be characterized as follows: forcipes interiores absent; forcipes superiores strongly chitinized an dilated at anex. Within this group, the forcipes of. A. seabrai sp. n. do not present an aberrant form. The "dissimilis group" will be studied in forthcoming papers. The limits of the genus Archyta Jaen. are not as yet sharply difined, the evaluation of the significance of each character used in the definition remaining as most difficult problem. The distinction between Archytas and other related genera is very difficult, chiefly because it is based on variable characters. In this paper we place the genera Parafabricia Towsend, 1931, Itachytas Blanchard, 1940, Archynemochaeta Blanchard, 1941, Proarchytoides Blanchard, 1941 and Archytodejeania Blanchard, 1941 in the synonymy of Archytas Jaen. The detailed examination of the characters used in their definition, proved them to be fundamentally proposed on basis of chaetotasy, these characters alone being precarious, because of the considerabel intraspecifical variation. The type of the new species are in the Oswaldo Cruz Institute collection. Rio de Janeiro, Brazil, and paratypes in the collections of the followings institutions: Departamento de Zoologia da Secretaria de Agricultura do Estado de São Paulo; Instituto de Ecologia e Experimemtação Agrícolas; Departamento de Defesa Sanitária Vegetal; Campos Seabra collection; and Barbiellini collection.