Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT) underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF) current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

Quantitative study of myocardial microcirculation in arterial hypertension due to progressive inhibition of NO synthesis

OBJECTIVE: To study the quantitative changes in intramyocardial blood vessels in rats in whom nitric oxide synthesis was inhibited. METHODS: Four groups of 10 rats were studied: control (C25 and C40) and L-NAME (L25 and L40). The animals L25 and L40 received L-NAME in the dosage of 50mg/kg/day for 25 and 40 days, respectively. On days 26 and 41 the animals in groups 25 and 40 were sacrificed. Analysis of the myocardium was performed using light microscopy and stereology. RESULTS: Arterial blood pressure and heart weight increased 74.5 and 57.8% after 25 days and 90.2 and 34.6% after 40 days, respectively. Comparing the L-NAME rats with the respective controls revealed that vessel volume density decreased 31.3% after 40 days, and the vessel length-density decreased 53.5% after 25 days and 25.7% after 40 days. The mean cross-sectional area of the vessels showed an important reduction of 154.6% after 25 days. The intramyocardial vessels decreased significantly in length- density in the L-NAME animals. The mean cross-sectional area of the vessels, which normally increases during heart growth between 25 and 40 days, showed a precocious increase by the 25th day in the L-NAME rats. This suggests an increase of the size of the heart, including blood vessels. CONCLUSION: The inhibition of the NO synthesis provokes rarefaction in the intramyocardial vessels that progresses with the time of administration of L-NAME.

Treatment of atrial fibrillation with radiofrequency ablation and simultaneous multipolar mapping of the pulmonary veins

OBJECTIVE: To demonstrate the feasibility and safety of simultaneous catheterization and mapping of the 4 pulmonary veins for ablation of atrial fibrillation. METHODS: Ten patients, 8 with paroxysmal atrial fibrillation and 2 with persistent atrial fibrillation, refractory to at least 2 antiarrhythmic drugs and without structural cardiopathy, were consecutively studied. Through the transseptal insertion of 2 long sheaths, 4 pulmonary veins were simultaneously catheterized with octapolar microcatheters. After identification of arrhythmogenic foci radiofrequency was applied under angiographic or ultrasonographic control. RESULTS: During 17 procedures, 40 pulmonary veins were mapped, 16 of which had local ectopic activity, related or not with the triggering of atrial fibrillation paroxysms. At the end of each procedure, suppression of arrhythmias was obtained in 8 patients, and elimination of pulmonary vein potentials was accomplished in 4. During the clinical follow-up of 9.6±3 months, 7 patients remained in sinus rhythm, 5 of whom were using antiarrhythmic drugs that had previously been ineffective. None of the patients had pulmonary hypertension or evidence of stenosis in the pulmonary veins. CONCLUSION: Selective and simultaneous catheterization of the 4 pulmonary veins with microcatheters for simultaneous recording of their electrical activity is a feasible and safe procedure that may help ablation of atrial fibrillation.

Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1) antiarrhythmic drugs, 2) symptoms of low cardiac output, and 3) intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation), catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein). One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation, with a final success rate of 66%, versus the global success rate of 44%. Patients with persistent atrial fibrillation were not good candidates for focal ablation.

Influence of balloon pressure inflation in patients undergoing primary coronary stent implantation during acute myocardial infarction: a quantitative coronary angiography analysis

OBJECTIVE:To verify the influence of moderate- or high-pressure balloon inflation during primary coronary stent implantation for acute myocardial infarction. METHODS: After successful coronary stent implantation, 82 patients were divided into 2 groups according to the last balloon inflation pressure: group 1 (³12 to <16 atm) and group 2 (³16 to 20 atm), each with 41 cases. All patients underwent late coronary angiography. RESULTS: In group 1, the mean stent deployment pressure was 13.58±0.92 atm, and in the group 2 it was 18.15±1.66 atm. Stents implanted with moderate pressures (³12 to <16 atm) had a significantly smaller postprocedural minimal lumen diameter, compared to with those with higher pressure, with lesser acute gain (2.7± 0.4 mm vs 2.9±04 mm; p=0.004), but the late lumen loss (0,9±0,8 mm vs 0,9±0,6 mm) and the restenosis (22% vs. 17.1%) and target-vessel revascularization rates (9.8% vs 7.3%) were similar between the groups. CONCLUSION: During AMI stenting, the use of high pressures (³16 atm) did not cause a measurable improvement in late outcome, either in the late loss, its index, and the net gain, or in clinical and angiographic restenosis rates.

Diferenças relacionadas ao sexo nos volumes ventriculares e na fração de ejeção do ventrículo esquerdo estimados por cintilografia de perfusão miocárdica: comparação entre os programas Quantitative Gated SPECT (QGS) e Segami

OBJETIVO: Analisar as diferenças relacionadas ao sexo nas medidas obtidas pelos programas Segami e Quantitative Gated SPECT (QGS). MÉTODOS: Cento e oitenta e um indivíduos assintomáticos sem evidência de cardiopatia foram submetidos a estudos de perfusão miocárdica. O volume diastólico final (VDF), volume sistólico final (VSF) e a fração de ejeção do ventrículo esquerdo (FEVE) foram quantificados pelos programas QGS and Segami para avaliar a influência do sexo, idade, peso, altura, freqüência cardíaca, pressão arterial sistólica, pressão arterial diastólica, índice de massa corporal e área de superfície corporal. RESULTADOS: As médias obtidas com o método QGS foram VDF (mulheres = 68 ml; homens = 95 ml; p < 0,001) e FEVE (mulheres = 66,24%; homens = 58,7%), e com o Segami, VDF (mulheres = 137 ml; homens = 174 ml) e FEVE (mulheres = 62,67%; homens = 58,52%). Foram observadas diferenças significantes entre homens e mulheres no VDF (p < 0,001) e VSF (p < 0,001), que persistiram após o ajuste em relação à área de superfície corporal. CONCLUSÃO: Os volumes ventriculares foram significantemente menores e a FEVE foi significantemente maior em mulheres, de acordo com os programas QGS e Segami.

Comparison between MDCT and Grayscale IVUS in a Quantitative Analysis of Coronary Lumen in Segments with or without Atherosclerotic Plaques

Background: The diagnostic accuracy of 64-slice MDCT in comparison with IVUS has been poorly described and is mainly restricted to reports analyzing segments with documented atherosclerotic plaques. Objectives: We compared 64-slice multidetector computed tomography (MDCT) with gray scale intravascular ultrasound (IVUS) for the evaluation of coronary lumen dimensions in the context of a comprehensive analysis, including segments with absent or mild disease. Methods: The 64-slice MDCT was performed within 72 h before the IVUS imaging, which was obtained for at least one coronary, regardless of the presence of luminal stenosis at angiography. A total of 21 patients were included, with 70 imaged vessels (total length 114.6 ± 38.3 mm per patient). A coronary plaque was diagnosed in segments with plaque burden > 40%. Results: At patient, vessel, and segment levels, average lumen area, minimal lumen area, and minimal lumen diameter were highly correlated between IVUS and 64-slice MDCT (p < 0.01). However, 64-slice MDCT tended to underestimate the lumen size with a relatively wide dispersion of the differences. The comparison between 64-slice MDCT and IVUS lumen measurements was not substantially affected by the presence or absence of an underlying plaque. In addition, 64-slice MDCT showed good global accuracy for the detection of IVUS parameters associated with flow-limiting lesions. Conclusions: In a comprehensive, multi-territory, and whole-artery analysis, the assessment of coronary lumen by 64-slice MDCT compared with coronary IVUS showed a good overall diagnostic ability, regardless of the presence or absence of underlying atherosclerotic plaques.

Estudos genéticos sôbre o milho tunicata

The study of pod corn seems still of much importance from different points of view. The phylogenetical importance of the tunicate factor as a wild type relic gene has been recently discussed in much detail by MANGELSDORF and REEVES (1939), and by BRIEGER (1943, 1944a e b). Selection experiments have shown that the pleiotropic effect of the Tu factor can be modified very extensively (BRIEGER 1944a) and some of the forms thus obtained permitt comparison of male and female inflorescences in corn and related grasses. A detailed discussion of the botanical aspect shall be given shortly. The genetic apect, finally, is the subject of the present publication. Pod corn has been obtained twice: São Paulo Pod Corn and Bolivia Pod Corn. The former came from one half ear left in our laboratory by a student and belongs to the type of corn cultivated in the State of São Paulo, while the other belongs to the Andean group, and has been received both through Dr. CARDENAS, President of the University at Cochabamba, Bolivia, and through Dr. H. C. CUTLER, Harvard University, who collected material in the Andes. The results of the studies may be summarized as follows: 1) In both cases, pod corn is characterized by the presence of a dominant Tu factor, localized in the fourth chromosome and linked with sul. The crossover value differs somewhat from the mean value of 29% given by EMERSON, BEADLE and FRAZER (1935) and was 25% in 1217 plants for São Paulo Pod Corn and 36,5% in 345 plants for Bolivia Pod Corn. However not much importance should be attributed to the quantitative differences. 2) Segregation was completely normal in Bolivia Pod Corn while São Paulo Pod Corn proved to be heterozygous for a new com uma eliminação forte, funcionam apenas 8% em vez de 50%. Existem cerca de 30% de "jcrossing-over entre o gen doce (Su/su) e o fator gametofítico; è cerca de 5% entre o gen Tu e o fator gametofítico. A ordem dos gens no cromosômio IV é: Ga4 - Tu - Sul. 3) Using BRIEGER'S formulas (1930, 1937a, 1937b) the following determinations were made. a) the elimination of ga4 pollen tubes may be strong or weak. In the former case only about 8% and in the latter 37% of ga4 pollen tubes function, instead of the 50% expected in normal heterozygotes. b) There is about 30,4% crossing-over between sul and ga4 and 5,3% between Tu and ga3, the order of the factors beeing Su 1 - Tu - Ga4. 4) The new gametophyte factor differs from the two others factors in the same chromosome, causing competition between pollen tubes. The factor Gal, ocupies another locus, considerably to the left of Sul (EMERSON, BEADLE AND FRAZSER, 1935). The gen spl ocupies another locus and causes a difference of the size of the pollen grains, besides an elimination of pollen tubes, while no such differences were observed in the case of the new factor Ga4. 5) It may be mentioned, without entering into a detailed discussion, that it seems remarquable that three of the few gametophyte factors, so far studied in detail are localized in chromosome four. Actuality there are a few more known (BRIEGER, TIDBURY AND TSENG 1938), but only one other has been localized so far, Ga2, in chromosome five between btl and prl. (BRIEGER, 1935). 6) The fourth chromosome of corn seems to contain other pecularities still. MANGELSDORF AND REEVES (1939) concluded that it carries two translocations from Tripsacum chromosomes, and BRIEGER (1944b) suggested that the tu allel may have been introduced from a tripsacoid ancestor in substitution of the wild type gene Tu at the beginning of domestication. Serious disturbances in the segregation of fourth chromosome factors have been observed (BRIEGER, unpublished) in the hybrids of Brazilian corn and Mexican teosinte, caused by gametophytic and possibly zygotic elimination. Future studies must show wether there is any relation between the frequency of factors, causing gametophyte elimination and the presence of regions of chromosomes, tranfered either from Tripsacum or a related species, by translocation or crossing-over.

Ontogenetic variation of plastral spotting pattern in Phrynops hilarii (Testudines, Chelidae)

The plastral spotting variation in the chelid turtle Phrynops hilarii (Duméril & Bibron, 1835) in relation to sex, size, and geographic procedence of individuals was analyzed. States for qualitative characters were analyzed using non-parametric tests. Quantitative characters (shell and scute measurements) were standardized for body size by linear regression against carapace length, and were subjected to principal components analysis and canonical discriminant function analysis. Results suggest that increased plastral spotting is a polymorphic ontogenetic trait in P. hilarii. Neither hatchlings nor juveniles have plastral pattern moderately or heavily pigmented. The simplest pattern, however, may persist without changes in some adults. There are no differences between sexes. The spatial distribution of the plastral pattern is not ordered latitudinally or longitudinally, showing no relationship with gradients of elevation, temperature, or precipitation. This pattern trait lacks of taxonomic significance. The morphometric analysis failed to reveal any character of diagnostic utility in the plastron to support the possibility that these patterns correspond to different sympatric taxa.

Quantitative fidelity of recent freshwater mollusk assemblages from the Touro Passo River, Rio Grande do Sul, Brazil

This study represents one of the first contributions to the knowledge on the quantitative fidelity of the recent freshwater molluscan assemblages in subtropical rivers. Thanatocoenoses and biocoenoses were studied in straight and meandering to braided sectors, in the middle course of the Touro Passo River, a fourth-order tributary of the Uruguay River, located in the westernmost part of the State of Rio Grande do Sul. Samplings were carried out through quadrats of 5 m², five in each sector. A total area of 50 m² was sampled. Samplings were also made in a lentic environment (abandoned meander), with intermittent communication with the Touro Passo River, aiming to record out-of-habitat shell transportation from the lentic communities to the main river channel. The results show that, despite the frequent oscillation of the water level, the biocoenosis of the Touro Passo River shows high ecological fidelity and undergoes little influence from the lentic vicinal environments. The taxonomic composition and some features of the structure of communities, especially the dominant species, also reflect some ecological differences between the two main sectors sampled, such as the complexity of habitats in the meandering-sector. Regarding the quantitative fidelity, 60% of the species found alive were also found dead and 47.3% of the species found dead were also found alive, at river-scale. However, 72% of the dead individuals belong to species also found alive. This value might be related with the good rank order correlation obtained for live/dead assemblages. Consequently, the dominant species of the thanatocoenoses could be used to infer the ecological attributes of the biocoenoses. The values of all the indexes analyzed were very variable in small-scale samplings (quadrat), but were more similar to others registered in previous studies, when they were analyzed in a station and river scale.

Quantitative method of viral pollution determination for large volume of water using ferric hydroxide gel impregnated on the surface of glassfibre cartridge

Quantitative method of viral pollution determination for large volume of water using ferric hydroxide gel impregnated on the surface of glassfibre cartridge filter. The use of ferric hydroxide gel, impregnated on the surface of glassfibre cartridge filter enable us to recover 62.5% of virus (Poliomylitis type I, Lsc strain) exsogeneously added to 400 liters of tap-water. The virus concentrator system consists of four cartridge filters, in which the three first one are clarifiers, where the contaminants are removed physically, without significant virus loss at this stage. The last cartridge filter is impregnated with ferric hydroxide gel, where the virus is adsorbed. After the required volume of water has been processed, the last filter is removed from the system and the viruses are recovered from the gel, using 1 liter of glycine/NaOH buffer, at pH 11. Immediately the eluate is clarified through series of cellulose acetate membranes mounted in a 142mm Millipore filter. For the second step of virus concentration, HC1 1N is added slowly to the eluate to achieve pH 3.5-4. MgC1, is added to give a final concentration of 0.05M and the viruses are readsorbed on a 0.45 , porosity (HA) cellulose acetate membrane, mounted in a 90 mm Millipore filter. The viruses are recovered using the same eluent plus 10% of fetal calf serum, to a final volume of 3 ml. In this way, it was possible to concentrate virus from 400 liters of tap-water, into 1 liter in the first stage of virus concentration and just to 3 ml of final volume in a second step. The efficiency, simplicity and low operational cost, provded by the method, make it feasible to study viral pollution of recreational and tap-water sources.

Molecular karyotype analysis and mapping of housekeeping genes to chromosomes of selected species complexes of Leishmania

The molecular karyotypes for 20 reference strais of species complexes of Leishmania were determined by contour-clamped homogeneous eletric field (CHEF) electrosphoresis. Determination of number/position of chromosome-sized bands and chromosomal DNA locations of house-keeping genes were the two criteria used for differentiating and classifying the Leishmania species. We have established two gel running conditions of optimal separation of chromosomes, wich resolved DNA molecules as large as 2,500 kilobase pairs (kb). Chromosomes were polymorphic in number (22-30) and size (200-2,500 kb) of bands among members of five complexes of Leishmania. Although each stock had a distinct karyotype, in general the differences found between strains and/or species within each complex were not clear enough for parasite identification. However, each group showed a specific number of size-concordant DNA molecules, wich allowed distinction among the Leishmania complex parasites. Clear differences between the Old and New world groups of parasites or among some New World Leishmania species were also apparent in relation to the chromosome locations of beta-tubulin genes. Based on these results as well as data from other published studies the potencial of using DNA karyotype for identifying and classifying leishmanial field isolates is discussed.