Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coração of the Medical School of USP from 1986 to 1995

OBJECTIVE: To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS: Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > 40% were analyzed. RESULTS: We studied 18,221 patients and observed a significant increase in the number of females (22.8% to 25.2%, P=0.001) and an increase in age (57.1±29.3 to 60.4±10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2% and 64.5%) and among the older patients (59.8±9.8 and 56.8±10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2% vs 69.2% and 33.8% vs 30.5%, respectively, P<0.0001). CONCLUSION: A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis.

Obstrucao Coronaria apos Implante por Cateter de Protese Valvar Aortica

Fundamentos: O implante por cateter de bioprótese valvar aórtica (TAVI) consolidou-se como alternativa para o tratamento de pacientes com estenose aórtica importante de alto risco cirúrgico. Contudo, há poucos dados na literatura com respeito à obstrução coronária que, apesar de rara, trata-se de grave complicação do TAVI. Objetivo: Avaliar, no contexto brasileiro, a presença dessa importante complicação. Métodos: Foram avaliados todos os casos de obstrução coronária incluídos no Registro Brasileiro de TAVI. Foram coletados dados clínicos, do procedimento, do manejo e de evolução intra-hospitalar. Resultados: Entre 418 pacientes consecutivos do registro, ocorreram três casos de obstrução coronária (incidência de 0,72%). Em sua totalidade, os pacientes eram do sexo feminino, sem cirurgia de revascularização miocárdica (CRM) prévia, com idade média de 85 ± 3 anos, EuroSCORE logístico de 15 ± 6% e STS de 9 ± 4%. Todos os casos foram realizados com a válvula balão-expansível Sapien XT. Em um dos pacientes, com dados de tomografia computadorizada pré-procedimento, verificaram-se origem das artérias coronárias baixa e seio de Valsalva estreito. Todos os pacientes apresentaram-se clinicamente com hipotensão importante e mantida, imediatamente após o implante da válvula, e, apesar de angioplastia com implante de stent, todos os pacientes foram a óbito, sendo dois periprocedimento e um durante hospitalização. Conclusão: A obstrução coronária como complicação do TAVI, apesar de rara, é potencialmente fatal, podendo ocorrer mais frequentemente em mulheres e com as próteses expansíveis por balão. Fatores anatômicos podem estar relacionados com sua ocorrência, ressaltando-se a importância de boa avaliação pré-procedimento no sentido de evitar essa grave complicação.

Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease

Abstract Background: Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy. Objective: To determine the risk factors associated with cardiovascular and neonatal complications. Methods: We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories. Results: Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity. Conclusion: The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).

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.

Morfología del aparato digestivo de Enteroctopus megalocyathus y Loligo sanpaulensis (Mollusca, Cephalopoda)

A detailed description of the morphology of the digestive organs of Enteroctopus megalocyathus (Gould, 1852) and Loligo sanpaulensis Brakoniecki, 1984 is given. The mandibles, the crop diverticulum, a doubly coiled caecum, the loop of the medium intestine and the appendages of the digestive gland are first described for E. megalocyathus. The most outstanding finding in L. sanpaulensis is the location of the single posterior salivary gland, wholly embedded in the digestive gland.

Plastic ingestion by sea turtles in Paraíba State, Northeast Brazil

ABSTRACT Currently, plastics are recognized as a major pollutant of the marine environment, representing a serious threat to ocean wildlife. Here, we examined the occurrence and effects of plastic ingestion by sea turtles found stranded along the coast of Paraíba State, Brazil from August 2009 to July 2010. Ninety-eight digestive tracts were examined, with plastic found in 20 (20.4%). Sixty five percent (n = 13) of turtles with plastic in the digestive tract were green turtles (Chelonia mydas), 25% (n = 5) were hawksbills (Eretmochelys imbricata), and 10% (n = 2) were olive ridley (Lepidochelys olivacea). More plastic was found in the intestine (85%) than in other parts of the gastrointestinal tract. We observed complete blockage of the gastrointestinal tract due to the presence of plastic in 13 of the 20 turtles that had ingested plastic. No correlation was found between the curved carapace length (CCL) and the number or mass of the plastic ingested items. Significant differences were found between the intake of hard and soft plastic and the ingestion of white/transparent and colored plastic, with soft and white/transparent plastics being more commonly ingested. This study reveals the serious problem of plastic pollution to sea turtles at the area.

Pesquizas sobre a acção physiologica das toxinas bacterianas: I. sobre a actividade physiologica dos filtrados de culturas do bacillo coli. Reacções do intestino isolado e perfundido

The writers report experiments performed with filtrates of old cultures od colon bacilli upon the isolated and perfused rabbit gut. According to the experiments the writers suppose to exist one or more substances in the filtrates of old cultures of colon bacilli with physiological activity upon the isolated and perfused rabbit gut. Such activity is essentially characterised by a rapid increase of the intestine tonus. When the Ringer-Tyrode solution containing the filtrate is removed and replaced by a fresh one, the increase of the tonus disappears. Liver-broth medium causes a somewhat increase of the tonus of the gut but much less in intensity.

Biologia do saguirú (Characidae, Curimatinae)

In Brazil all the fishes belonging to the sub-family Curimatinae are called « saguirú ». The present work gives a biological study of the Curimatus elegans Steind., a small fish without any economical importance, which is to be found along the whole brazilian coast, down till Paraguay. The specimens utilized for the present study come from Fortaleza (Ceará, north-eastern Brazil). The C. elegans is « ilyophagus », that means, it feeds itself exclusively with those organic materials to be found in mud, specially with microscopical algae. The intestines are very extent, some of them measuring about 9 to 11 times body's length. Studies have been made about growth and age of the C. elegans; the biggest sizes found were of 153 mm. for females and 88 mm. for males. The C. elegans shows developed sexual glands during a long period (April to September). The movements of the spermatozoa, in contact with water is of 40 to 50 seconds of intense movements, ceasing after 70 to 100 seconds. In contact with 0.5% NaCl-solution spermatozoa show a big increase in movements-time, that can last till about 25 minutes. The eggs' diameter measures 0.70 to 0.73 mm., mature and hydrated it attains 0.93 to 1,00 mm. There is a certain correlation between the size of the body and the quantity of eggs. Big specimens can produce a total of 200.000 eggs. The average quantity contained in 1 gr. and 1 cc. is 6018 and 6229 eggs, respectively. Maturity and spawning in laboratory has been obtained due to injections of suspension of fish-hypophysis. Three or four hours after the injection, fishes show more movement and evident signs of excitation, proceeding spawning after 5 to 6 hours. Males, persecuting females, describe successive circles (merry-go-round) - carroussel), swimming side by side with females up to water's surface, where sexual products are start beating dry, for there is no blood yet. Circulation-scheme is to be found on fig. 4 and 5. The swim-bladder and the stomach are but delineated; the intestine is formed by a cylindric tube, all closed. At the place, where later on there will open the mouth, we find a group of ciliary hairs that produce a liquid current, very evident by the semi-circle formed by attached solid particles. After 36 hours, opening of the mouth and formation of the gill slits begin. At the age of 90 hours (4 mm.) the larvas swim well and start to feed themselves; the digestive tube is now all open and the swimbladder works already. During the first days of life, larvas have an adhesive organ situated at their frontal region (fig. 7) in form of a crescent, by means of which they hang to surrounding vegetation (fig. 6). When the larva begins to swim and to feed itself and its yolk are having been absorbed. the adhesive organ retracts and disappears. While larvas and alevins feed themselves with plancton, they have small eye-teeth, which disappear,. when fishes become « ilyophagus ». There exist too, during their life as larvas, pharyngeal-teeth. The lateral line appears in the larva after 16 to 18 days; more or less at the same time all fins are completely developed. Shortly after, first scales appear (20 to 23 days). Evolution of intestines twisting followed (fig. 9). Larvas show at different parts of their bodies small of organs excretory functions, that are constituted by bottons in serial disposition, every one with an excretory canal that opens towards the outside. These formations disappear suddenly when larvas attain their phase of alevin. The existence of a great number of said formations at the caudal fin (fig. 12) is of great interest. In our experiences of breeding we have employed several thousands of C. elegans larvas in different environs and we made conditions of surrounding change (illumination), depth of water, temperature, presence of sand at bottom of aquariums and without sand, food). In this way we could compare the results obtained, estimate the action of each factor for the realisation of a good bring-up of larvas.

Contribution to the normal fecal flora of the hamster: Proteus mirabilis in normal feces of hamster

Proteus mirabilis must be considered a normal inhabitant of the intestine of hamsters. It is also found in the vaginal secretion of females of this animal, when in oestrus.

Plancto e hidrobiologia sanitária de tanques tropicais com dáfnias e rotíferos

The engineers of the modern University City are constructing a graceful bridge, named PONTE OSWALDO CRUZ, that crosses a portion of the Guanabara Bay (Fig. 1). The work at west pillar stopped for 3 years (The concret structure in Est. 1). As it will be seen from n.º 1 — 5 of the fig. 1, Est. I, the base of the structure will have five underground boxes of reinforcement, but, to-day they are just like as five uncovered water ponds, until at present: May 1963. (Est. I — fig. 3, n.º 3 — pond n.º 3; A. — old level of the water; B.— actual level of the water; c.— green water; E.— mass of bloom of blue algae Microcystis aeruginosa). Soon after SW portion, as 5 cells in series, of the pillar abutments, and also the NE portion nearly opposite in the Tibau Mount will be filled up with earth, a new way will link Rio City and the University City. We see to day Est. I, fig. 1 — the grasses on the half arenous beach of the Tibau Point. These natural Cyperaceae and Gramineae will be desappear because of so a new road, now under construction, when completed will be 33 feet above the mean sea level, as high as the pillar, covering exactly as that place. Although rainfall was the chief source of water for these ponds, the first water (before meterorological precipitations of whatever first rain it might fall) was a common tap water mixed with Portland Cement, which exuded gradually through the pores of the concret during its hardenning process. Some data of its first cement water composition are on the chemical table, and in Tab. n.º 4 and "Resultado n.º 1". The rain — receiving surface of each pond were about 15 by 16 feet, that is, 240 square feet; when they were full of water, their depth was of 2 feet 3", having each pond about 4,000 gallons. Climatic conditions are obviously similar of those of the Rio de Janeiro City: records of temperature, of precipitation and evaporation are seen on the graphics, figs. 2, 3, 4. Our conceptions of 4 phases is merely to satisfy an easy explanation thus the first phase that of exudation of concrete. We consider the 2nd. phase formation of bacterian and cyanophycean thin pellicel. 3rd. phase - dilution by rains, and fertilisation by birds; the 4th phase - plankton flora and fauna established. The biological material arrived with the air, the rains, and also with contaminations by dusts; with big portion of sand, of earth, and leaves of trees resulted of the SW wind actions in the storming days (See - Est. I, fig. 3, G. - the mangrove trees of the Pinheiro Island). Many birds set down and rest upon the pillar structure, its faeces which are good fertilizers fall into the ponds. Some birds were commonly pigeons, black ravens, swallows, sparrows and other sea mews, moor hens, and a few sea birds of comparatively rare occurence. We get only some examples of tropical dust contaminated helioplankton, of which incipient observations were been done sparcely. See the systematic list of the species of plankters. Phytoplankters - Cyanophyta algae as a basic part for food of zooplankters, represented chiefly by rotiferse, water-fleas Moinodaphnia and other Crustacea: Ostracoda Copepoda and Insecta: Chironomidae and Culicidae larvae. The polysaprobic of septic irruptions have not been done only by heating in summer, and, a good reason of that, for example: when the fifth pond was in polysaprobic phase as the same time an alike septic phase do not happened into the 3rd. pond, therefore, both were in the same conditions of temperature, but with unlike contaminations. Among the most important aquatic organisms used as indicatiors of pollution - and microorganisms of real importance in the field of sanitary science, by authorities of renown, for instance: PALMER, PRESCOTT, INGRAM, LIEBMANN, we choose following microalgae: a) The cosmopolite algae Scenedesmus quadricuada, a common indicator in mesosaprobio waters, which lives between pH 7,0 and it is assimilative of NO[3 subscripted] and NH[4 subscripted]. b) Species of the genus Chlamydomonas; it is even possible that all the species of theses genus inhabit strong-mesosaprobic to polysaprobic waters when in massive blooms. c) Several species of Euglenaceae in fast growing number, at the same time of the protozoa Amoebidae, Vorticellidae and simultaneous with deposition of the decaying cells of the blue algae Anacystis cyanea (= Microcystis) when the consumed oxygen by organic matter resulted in 40 mg. L. But, we found, among various Euglenacea the cosmopolite species (Euglena viridis, a well known polysaprobic indicatior of which presence occur in septic zone. d) Analcystis cyanea (= M. aeruginosa) as we observed was in blooms increasing to the order of billions of cells per litter, its maximum in the summer. Temperatures 73ºF to 82ºF but even 90ºF, the pH higher than 8. When these blue algae was joined to the rotifer Brachionus calyflorus the waters gets a milky appearance, but greenished one. In fact, that cosmopolite algae is used as a mesosaprobic indicator. Into the water of the ponds its predominance finished when the septic polysaprobic conditions began. e) Ankistrodesmus falcatus was present in the 5th pond from 26the. April untill the 26th July, and when N.NH[4 subscripted] gets 1.28 mg. L. and when chlorinity stayed from 0.034 to 0.061 mg. L. It never was found at N.NH[4 subscripted] higher than 1 mg. L. The green algae A. falcatus, an indicatior of pollution, lives in moderate mesosaprobic waters. f) As everyone knows, the rotifer eggs may be widely dispersed by wind. The rotifer Asplanchna brightwelli in our observation seemed like a green colored bag, overcharged by green cells and detritus, specially into its spacious stomach, which ends blindly (the intestine, cloaca, being absent). The stock of Asplanchna in the ponds, during the construction of the bridge "PONTE OSWALDO CRUZ" inhabits alkaline waters, pH 8,0 a 8,3, and when we observed we noted its dissolved oxygen from 3.5 to 4 mg. L. In these ponds Asplanchna lived in 0,2 P.PO[4 subscripted]. (Remember the hydobiological observations foreign to braslian waters refer only from 0.06 to 0,010 mg. L. P.PO[4 subscripted]; and they refer resistance to 0.8 N.NH[4 subscripted]). By our data, that rotiger resist commonly to 1.2 until 1.8 mg. L.N.NH[4 subscripted]; here in our ponds and, when NO[2 subscripted] appears Asplanchna desappears. It may be that Asplanchna were devoured by nitrite resistant animals of by Culicidae or other mosquitoes devoured by Due to these facts the number and the distribution of Asplanchna varies considerabley; see - plates of plankton successions. g) Brachionus one of the commonest members of class Rotatoria was frquently found in abundance into the ponds, and we notice an important biological change produce by the rotifer Brachonus colyciflorus: the occurence of its Brachionus clayciflorus forms pallas, is rare in Brazil, as we know about this. h) When we found the water flea MOinodaphnia we do not record simultanous presence of the blue algae Agmenellun (= Merismopedia).

Gorgorhynchus Trachinotus n.sp. and new host records for Dollfusentis Chandleri Golvan, 1969 (Paleacanthocephala, Echinorhynchoidea)

Gorgorhynchus trachinotus recovered from the intestine of trachinotus goodei Jordan & Evermann, 1896 is proposed as a new species and three new host records are reported for Dollfusentis chandleri Golvan, 1969.

Patogenesis of pipe-stem fibrosis of the liver (experimental observation on murine Schistosomiasis)

Mice infected with 30 cercariae of Schistosoma mansoni developed portal and septal fibrosis due to the massive and concentrated deposition of eggs in the periportal areas which occurred following the 16th week after infection. The lesion resembled pipe-stem fibrosis seen in human hepatosplenic schistosomiasis in the following characters: portal fibrosis interconnecting portal spaces as well as portal spaces and central canals; portal inflammation; periovular granulomas; vascular obstruction and telangiectasia. The liver parenchyma maintained its normal architecture. Vascular injection techniques with Indian ink and vinylite revealed that the portal system developed numerous dilated collateral venules coming from the large and medium-sized portal branches, about 10 weeks after schistosome infection. The lodging of schistosome eggs into these collaterals resulted in granulomatous inflammation and fibrosis along all the portal tracts, thus forming the pipe-stem lesion. Although not readily demonstrable grossly, the pipe-stem fibrosis of murine schistosomiasis has many similarities with the human lesion and can be considered to have the same basic pathogenesis.

Congenital and nursing effects on the evolution of Schistosoma mansoni infection in mice

Modification of the immune response to schistosomal infection in children or offspring born to mother R infected with Schistosoma mansoni has been demonstrated in human and in experimental schistosomiasis. One of the hypothesis to explain this fact could be the transfer of circulating antigens and antibodies from mother to foetus through the placenta or from mother to child by milk. The results of this spontaneous transference are controversial in the literature. In an attempt to investigate these questions, we studied one hundred and twenty offspring (Swiss mice), sixty born to infected-mothers (group A) and sixty born to non-infected mothers (group B). These were percutaneously infected with 50 cercariae/mouse, and divided in six sub-groups (20 mice/sub-group), according to the following schedule: after birth (sub-groups A.I and B.I), 10 days old (sub-groups A.II and B.II) and 21 days old (sub-groups A.III and B.III). After the exposure period, the young mice returned to their own mothers for nursing. Six weeks later, the mice were killed. We obtained the following results: 1) There is transference of antibody to cercariae (CAP), adult worms (SWAP) and egg antigens (SEA) from the infected mothers to the offspring, probably through placenta and milk; 2) Offspring born to infected mothers exhibit much less coagulative hepatic necrosis and show a lower number of eggs in the small intestine and a less intense and predominant exsudative stage of the hepatic granulomas when compared with the exsudative-productive stage of the control groups. The findings suggest that congenital and nursing factors can interfere on the development of the schistosomiasis infection, causing an hyporesponse to the eggs.

Redescription of Oncophora melanocephala (Rudolphi, 1819) Baudin-Laurencin, 1971 (Nematoda, Camallanidae)

Oncophora melanocephala, a camallanid nematode from the small intestine of Priacanthus arenatus Cuvier, 1829 is redescribed from the Coast of Rio de Janeiro State, Brazil and this occurrence represents a new host record for the species

The genus lobatostoma (Trematoda: Aspidocotylea) in the pacific coast of South America, with description of Lobatostoma veranoi new species, parasite of Menticirrhus ophycephalus (Teleostei: Sciaenidae)

The presence of three aspidocotyleans trematodes in marine fishes from Perú and Chile is reported. One of them, Lobatostoma veranoi from the intestine of Menticirrhus ophicephalu (Sciaenidae) is considered a new species. Distinct characteristcs of the new species are:a cirrus sac smaller than the pharynx; tail overlapping posteriorly the ventral disk; testis in the last third of the body and the presence of 64-66 marginal alveoli. The two other species are Lobatostoma pacificum Manter, 1940 found in Trachinotus paitensis Cuvier, 1830 from Perú and Chile and Lobatostoma Anisotremum Oliva & Carvajal, 1984 from the intestine of Anisotremus scapularis (Tschudi, 1844) from Perú.