Lowering Pulmonary Wedge Pressure after Heart Transplant: Pulmonary Compliance and Resistance Effect

AbstractBackground:Right ventricular (RV) afterload is an important risk factor for post-heart transplantation (HTx) mortality, and it results from the interaction between pulmonary vascular resistance (PVR) and pulmonary compliance (CPA). Their product, the RC time, is believed to be constant. An exception is observed in pulmonary hypertension because of elevated left ventricular (LV) filling pressures.Objective:Using HTx as a model for chronic lowering of LV filling pressures, our aim was to assess the variations in RV afterload components after transplantation.Methods:We retrospectively studied 159 patients with right heart catheterization before and after HTx. The effect of Htx on hemodynamic variables was assessed.Results:Most of the patients were male (76%), and the mean age was 53 ± 12 years. HTx had a significant effect on the hemodynamics, with normalization of the LV and RV filling pressures and a significant increase in cardiac output and heart rate (HR). The PVR decreased by 56% and CPA increased by 86%. The RC time did not change significantly, instead of increasing secondary to pulmonary wedge pressure (PWP) normalization after HTx as expected. The expected increase in RC time with PWP lowering was offset by the increase in HR (because of autonomic denervation of the heart). This effect was independent from the decrease of PWP.Conclusion:The RC time remained unchanged after HTx, notwithstanding the fact that pulmonary capillary wedge pressure significantly decreased. An increased HR may have an important effect on RC time and RV afterload. Studying these interactions may be of value to the assessment of HTx candidates and explaining early RV failure after HTx.

Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure

Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.

Envelhecimento das aguardentes

1 - Colour, by itself, does not constitute a solid ground for judging of the age of a brandy because the more or less pronounced colour it acquires through aging can also be obtained by the addition of oack essence to newly distilled brandy. 2 - Urder the same conditions, colour intensity of a brandy wiU depend upon the nature of the wood and the condition of the storage. 3 - In accordance with the experimental results obtained by the present writers it rests no doubt that fermentation facility ferment resistence, produce and quality of the brendy all are factors depending upon the variety of the sugar cane. In addition, the authors presume that the variety of sugar cane has also influence upon the alteration of composition of the brandy submitted to aging. 4 - All aging phenomena of the brandy are accompanied by volume decreasing, what happens in a slow and continuous manner depending upon storage and environment conditions 5 - During brandy aging the alcoholic degree is greatly af- fected by evaporation, increasing or decreasing in accordance to the hygrometric state of the air and the teriperature in the place where the tuns are stored. 6 - The specific weight of the brandy is inversely proportio- nal to its alcoholic degree, but directly proportional to the extracts since the latter indicates the amount of dissolved residues. 7 - Brandy which shows high specific weight together with high alcoholic degree cannot be considered as aged. It may, however, be takens for brandy artificially coloved in order to conceal its actual age. 8 - The amount of extracts increases with aging, since it is the result of the solvent action of the brandy upon the soluble extractive substances of the wood. Notwithstanding that the extract, considered alone, has no value in determining the age of a brandy, since nothing easier is ohan to nake it change artificially. 9 -During aging the brandy get acidity in physiological as well as in physical way, but never by the action of microorganisms. 10 - The estturs produced during aging by the action of acids upon alcohols are the mean factors of the savour (bouquet) of a brandy and therefore every thing shall be done tor fhr estherification of a preserved brandy being not limited. 11 - Aeration increases esther formation, reduces the aging- time and turn better the taste qualities of the brandy. 12 - Due to the great proportion of high alcohols ordinarily found in the brandy, their analytical discrimination will be greatly important. 13 - The high alcohols are not responsable for the disastrous consequences of the alcoholism, but the high percentage of uthyl alcohol present in the brandy. 14 - The aldehydes appear always in high rate in the brazilian brandys in consequence of some intermediary products of the oxydation of the alcohols being left in the brandys during aging. 15 - The age has little or no influence on the quantity of phurphurol present in a brandy whose amount varies greatly the manner in which the wines to be distilled are treated. Wines centrifugalized or filtered before distillation always give rise to brandys poorer in phurphurol as compared with those distilled without these treatments. 16 - Though greatly variable, brandys of good qualities generally show a high residues coefficient, never under 200 mmg 17 - Lusson - Rocques oxydation coefficient cannot be indis- criminately applied to any brandy class, being, on the contrary, specifically destined to cognacs.

Estudo comparativo entre silagem de milho e cana taquara na alimentação suplementar de vacas leiteiras

The A. A. compare corn silage (Zea mays L.) with sugar cane (Saccharum sinensis Roxb.) in the supplementary feeding of dairy cow. Both the feeds were studied in relation to the following points: composition and nutritive value; influence of milk production, milk fat, milk acidity and body weight; cost of production. Both corn silage and sugar cane were analysed by ordinary methods, and their digestibility was determined by means of digestibility coefficients; their composition and nutritive value are, practically, equivalent, but silage showed slight superiority. The feeding experiment was carried out with two groups of six Holstein Friesian cows each, of the Escola Superior de Agricultura "Luiz de Queiroz" herd. Both groups were fed with the same basic concentrates mixture, calculeted according to MORRISON. During the various periods of the experiment, only the roughage supplement varied. The supplementary feeding consisted of 15 kg of chopped sugar cane or corn, silage, per day and per cow, given in two daily meals in the barn. At 4,30 p.m., the cows are set free in the field, where they pass the over night. The experiment was divided into six periods, in which there was a gradative change of the supplementary feeding between the two groups. The milk was weighed every day; the analysis of milk fat and acidity and the weighing of the animals, were made only on the first three days of every week. The analysis of data showed that: a) Milk production was increased significantly by silage feeding; b) The ri was not any influence on milk fat; c) The silage caused higher milk acidity; d) The sugar cane gave a greater increase of body weight. The cost of production of corn silage was 2,12 time higher, than sugar cane, hence, although the silage gave a higher milk production, its use is not economical, compared with sugar cane, in our conditions.

Dois teoremas sôbre a função gama

This paper proves the following theorems on the gamma function: Theorem I The integral ∫O∞ t u e-t dt = Γ ( u + 1 ) , where u, real or complex, is such that R (u) > -1, will not change its value if we substitute z = Q (cos φ + i sen φ) for the real variable t, being jconstant and such that - Π/2 < φ < Π/2 , Theorem II The integral ∫-∞∞ w2u + 1 e -w² dw = Γ ( u + 1 ) , where 2u + 1 is supposed to be a non negative even integer, will not change its value if we substitute z = w + fi, f being a real constant, for the real variable w. The proof of both theorems is obtained by means of the well known Cauchy theorem on contour integrals on the complex plane, as suggested by CRAMÉR (1, p. 126) and LEVY (3, p. 178).

Toxoplasmose congênita

We had the opportunity to study 6 cases of the congenital form of toxoplasmosis, found in a series of 1200 necropsies of fetuses and newborn babies, realized at 3 different hospitals in Rio de Janeiro, Brazil. Among the 6 cases, 4 were premature babies liveborn at the 6th-8th gestational month and 2 were stillborn (1 premature and 1 at term). In all those cases, the diagnosis was based in the detection of the parasite in tissues and in one case it was even isolated the Toxoplasma from the necrotic material found in the cranial cavity. This strain of Toxoplasma, pathogenic to pigeons, to guinea pigs and to mice, is preserved by successive transfers in mice. Some facts observed in those cases present an interest not only strictly anatomic but also have certain value for the better acknowlegment of the disease. First, we want to call the attention to the presence of a sudden high fever, during or just before pregnancy in the 4 cases in which the maternal anamnesis was perfectly studied; this fever that was preceded by a normal beginning of pregnancy, had relatively rapid remission, but in 2 cases was immediately followed by uterine bleeding and premature delivery, although the puerperium had been apparently normal. It is known that are normal the subsequent children of the mothers that delivered a baby with toxoplasmosis and that several women have normal babies before the toxoplasmotic one. We believe that the fever observed in our cases could be indicative of the beginning of maternal infection and those are the reasons why we emphasize the need of careful anamnesis, specially in the cases actually diagnosed as inapparent infection. Another fact to notice is that in 5 of our cases the event premature delivery happened always between the 6th and the 8th months of pregnancy, and the only term fetus was delivered in advanced stage of maceration. The above mentioned facts could agree with the opinion of FRENKEL (1949), when he declared that "primary infection of the pregnant mother appears more likely to be the commoner mode of fetal toxoplasmic infection", but they would disagree with WEINMAN (1952) who believes that the transmission of Toxoplasma to the fetus is more frequent through a pregnant woman with chronic disease and who says "that infection contracted during pregnancy may and probably does happen from time to time"...Still in connection with the transmission of toxoplasmosis, we want to note the verification of inflammatory lesions in the placental villi and in the umbilical cord in 3 of the 4 cases in which such organs were examined at the microscope. In the case n. 1, we found several pseudocysts of Toxoplasma in the placenta, and the fibroblasts of Wharton's jelly were particularly rich in isolated forms and in colonies of Toxoplasma; the easy multiplication of the parasite in that tissue calls the attention and even suggests its utilisation for Toxoplasma's cultivation. The confirmation of Toxoplasma in human placenta was made only recently by CRISTEN et al. (1951) and by NEGHME et al. (1952), in Chile; it is not frequent in the literature, what gives some value to our present verification. Another observation was that provided by the case n. 6. This baby, a premature one of the 6th month, was 14 days old and-died with signs of respiratory disease, the causa mortis have been pneumonia. At the necropsy, we found no gross change that suggested toxoplasmosis, except the presence of some small necrotic focuses in the cerebral nervous substance around the ventricles. As a matter of fact, there was no enlargement of spleen or liver and neither leptomeningitis nor hydrocephalus. Such focuses were attributed to possible anoxia and in fact they are extremely similar to anoxial softenings, even when they are examined at the microscope; its structure composed of a central necrotic zone, surrounded by proliferated neuroglia and by a variable deposit of calcium salts, closely simulated the anoxial softenings, when the microscopical examination is based in the common histological preparations (hematoxilin-eosin, etc.). But when we examine preparations by the Giemsa or by the periodic acid-Schiff methods, we will note the presence of Toxoplasma, with its typical aspect or a little changed by degeneration. When we describe this observation, we wish to evidence the need of the search of Toxoplasma and closed parasites, in the cases of supposed pure anoxial softenings of nervous substance, in children. The frequency with which the congenital toxoplasmosis was anatomically verified should be emphasized, although the disease had not been clinically suspected, and it should be borne in mind that the second case of toxoplasmosis reported in the world was observed in Brazil by MAGARINOS TORRES; this case was the first to be described of the generalized congenital form of the infection, i. e. with myocardial lesions and parasites in skeletal muscles and skin.

The change of behavior of two strains of Leishmania after cultivation in a defined medium

Attempts have been made to characterize two strains of Leishmania that became infective to golden hamsters only after they had been maintained for several years in a chemically defined culture medium. Observations were made on the growth rates of promastigotes in vitro, course of infection in hamsters, morphology of amastigotes, and electrophoretic mobility patterns of eight isoenzymes. Information was obtained about the buoyant densities of n-DNA and k-DNA, and one strain was tested against monoclonal antibodies. The identity of both strains remains obscure.

The value of ultrasonography in assessment of portal hypertension in hepatosplenic schistosomiasis

Ultrasonography can reveal most of the manifestations of portal hypertension complicating hepatosplenic, schistosomiasis. However, direct demonstration of gastroesophageal varices by ultrasonography is still very difficult. An attempt was done to correlate sonographic features of portal hypertension with the degree of fibrosis to screen patients having varices and predicting their chance of bleeding. The results obtained were found to be consistent with the esophagogastric endoscopy and with history of hematemesis. Four parameters were used, size of spleen, degree of periportal fibrosis, presence of collaterals and portal vein diameter. A pilot field survey was also done adopting the same principle.

Climatic change in northeastern Brazil: paleoparasitological data

Trichuris eggs were observed in Kerodon rupestris coprolites dated 9,000 years before present, collected in archeological sites of São Raimundo Nonato, northeastern Brazil. However, present day local rodents seem not to be infected by the parasite, suggesting its disappearence due to climatic changes.

Predictive value of the acid fast smear for detection of Mycobacterium tuberculosis in respiratory specimens in a Reference Center of HIV/Aids in Rio de Janeiro, Brazil

In order to evaluate the predictive value of acid fast bacilii (AFB) smear for the diagnosis of Mycobacterium tuberculosis in respiratory specimens in a setting with a high prevalence of Aids and an unknown prevalence of nontuberculous mycobacteria (NTM), we retrospectively examined specimens cultured for mycobacteria between 1 September 1993 and 30 September 1994 and medical records of patients with positive culture in a General Hospital, Aids reference in Rio de Janeiro, Brazil. Seventy three per cent (1517/2077) of samples were respiratory specimens and mycobacteria were recovered from 20.6% (313/1517) of these. M. tuberculosis was identified in 94.2% (295/313) and NTM in 5.8% (18/313). The yield of positive AFB smear and of positive culture was 6.1% (93/1517) and 20.6% (313/1517), respectively. The positive predictive value (PPV) of AFB for M. tuberculosis was 98.4% in expectorated sputum and 96.4% in bronchoalveolar lavage. Forty four percent (130/295) of specimens with positive culture for M. tuberculosis and 66.7% (12/18) for NTM were from patients HIV positive. The conclusion was that in our study population, the PPV of AFB for M. tuberculosis in respiratory specimens was high and the prevalence of NTM was low despite the high prevalence of HIV positive.

An ocellar "pupil" that does not change with light intensity, but with the insect age in Triatoma infestans

The simple eyes (ocelli) of recently emerged adult Triatoma infestans exhibit a narrow elongated "pupil", surrounded by a ring of brown-reddish pigment, the "iris". This pupil does not respond to changes in the illumination, but varies in size after the imaginal ecdysis. This change corresponds, internally, with the growth of the corneal lens and the associated retina up to an age of about 20 days. This has not been previously observed in an insect. The use of this characteristic for recognising young adults of this species is suggested.