Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children

OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19± 0.09 (T0), 7.16±0.13(T1), and 7.32±0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

Consequences of the Prolonged Waiting Time for Patients Candidates for Heart Surgery

OBJECTIVE - To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery. METHODS - From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases. RESULTS - The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery. CONCLUSION - Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.

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.

Prognostic value of technetium-99m-labeled single-photon emission computerized tomography in the follow-up of patients after their first myocardial revascularization surgery

OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT) in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole) and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina) and "any" (major event or coronary angioplasty or new myocardial revascularization surgery). RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

OBJECTIVE: To investigate preoperative predictive factors of severe perioperative intercurrent events and in-hospital mortality in coronary artery bypass graft (CABG) surgery and to develop specific models of risk prediction for these events, mainly those that can undergo changes in the preoperative period. METHODS: We prospectively studied 453 patients who had undergone CABG. Factors independently associated with the events of interest were determined with multiple logistic regression and Cox proportional hazards regression model. RESULTS: The mortality rate was 11.3% (51/453), and 21.2% of the patients had 1 or more perioperative intercurrent events. In the final model, the following variables remained associated with the risk of intercurrent events: age ³ 70 years, female sex, hospitalization via SUS (Sistema Único de Saúde - the Brazilian public health system), cardiogenic shock, ischemia, and dependence on dialysis. Using multiple logistic regression for in-hospital mortality, the following variables participated in the model of risk prediction: age ³ 70 years, female sex, hospitalization via SUS, diabetes, renal dysfunction, and cardiogenic shock. According to the Cox regression model for death within the 7 days following surgery, the following variables remained associated with mortality: age ³ 70 years, female sex, cardiogenic shock, and hospitalization via SUS. CONCLUSION: The aspects linked to the structure of the Brazilian health system, such as factors of great impact on the results obtained, indicate that the events investigated also depend on factors that do not relate to the patient's intrinsic condition.

Can patients with left main coronary artery disease wait for myocardial revascularization surgery?

OBJECTIVE: To assess the occurrence of cardiac events in patients diagnosed with left main coronary artery disease on diagnostic cardiac catheterization and waiting for myocardial revascularization surgery. METHODS: All patients diagnosed with left main coronary artery disease (stenosis > or = 50%) consecutively identified on diagnostic cardiac catheterization during an 8-month period were selected for the study. The group comprised 56 patients (40 males and 16 females) with a mean age of 61±10 years. The cardiac events included death, nonfatal acute myocardial infarction, acute left ventricular failure, unstable angina, and emergency surgery. RESULTS: While waiting for surgery, patients experienced the following cardiac events: 7 acute myocardial infarctions and 1 death. All events occurred within the first 60 days after the diagnostic cardiac catheterization. More patients, whose indication for diagnostic cardiac catheterization was unstable angina, experienced events as compared with those with other indications [p=0.03, relative risk (RR) = 5.25, 95% confidence interval = 1.47 - 18.7]. In the multivariate analysis of logistic regression, unstable angina was also the only factor that independently contributed to a greater number of events (p = 0.02, OR = 8.43, 95% CI =1.37 - 51.7). CONCLUSION: Unstable angina in patients with left main coronary artery disease acts as a high risk factor for cardiac events, emergency surgery being recommended in these cases.

Risk stratification with troponin I in patients undergoing myocardial revascularization surgery

OBJECTIVE: To determine the immediate behavior and the prognostic value in terms of late survival of serum troponin I measurement in patients undergoing myocardial revascularization surgery with extracorporeal circulation. METHODS: We studied 88 random patients, 65 (73.8%) of the male sex, who underwent myocardial revascularization surgery with extracorporeal circulation. Troponin measurements were performed as follows: in the preoperative period, right after intensive care unit admission, and on the first and second postoperative days. Values below 0.1 nanogram per milliliter (ng/mL) were considered normal. The cut points for late prognostic assessment were 0.5 ng/mL; 1 ng/mL; 2.5 ng/mL; and 5 ng/mL. RESULTS: The serum troponin I levels were elevated on the first postoperative day, suggesting the occurrence of specific myocardial damage. Patients with a poor prognosis could be identified, because the serum levels above 2.5 ng/mL and 5 ng/mL in the postoperative period resulted, respectively, in mortality rates of 33% and 50% in a maximum 6-month follow-up. CONCLUSION: Troponin I values around 2.5 ng/mL in the postoperative period should call attention to the need for more aggressive diagnostic or therapeutical measures.

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation.

A penectomia como técnica de controlo reprodutivo da espécie invasora Trachemys scripta em contexto zoológico

Dissertação de Mestrado Integrado em Medicina Veterinária

Sistemática filogenética y biología reproductiva con énfasis en solanum y capsicum (solanaceae). Systematics, phylogeny and reproductive biology with emphasis in solanum and capsicum (solanaceae).

Muchas respuestas a preguntas básicas sobre relaciones evolutivas, ubicación sistemática y evolución de caracteres morfológicos y ecológicos pueden ser obtenidas a través de las reconstrucciones filogenéticas. Sobre este contexto se pretende encarar en este proyecto estudios de filogenia molecular, revisiones sistemáticas, biología reproductiva y citogenética en Solanáceas americanas. Se intentará resolver la delimitación específica de Solanum sect. Solanum y Geminata, y Capsicum, y establecer relaciones filogenéticas en estos grupos. Se harán revisiones analizándose caracteres vegetativos y reproductivos críticos para evaluar su variabilidad y definir su valor taxonómico; para los estudios moleculares se utilizarán los marcadores ndhF, trnT-L, trnL-F y waxy. En base a los resultados se propondrán agrupamientos y relaciones de parentesco. Además, se hará un estudio cariosistemático para caracterizar y circunscribir especies en Solanum y miembros de la tribu Physaleae, y hasta variedades y/o cultivares en Capsicum, mediante técnicas clásicas y de bandeos de fluorescencia y AgNOR e hibridación in situ fluorescente (FISH). A nivel reproductivo, se estudiará la ecofisiología en las estructuras masculinas y su incidencia en la fructificación en Capscium baccatum. El desarrollo de esta temática comprende experiencias in vivo (a campo y en laboratorio) así como estudios histológicos y químicos.Se espera avanzar en la resolución de algunos problemas: 1) la complicada delimitación de especies de los taxones en estudio; 2) las relaciones filogenéticas en algunos de ellos; 3) la falta de conocimiento de la organización genómica; 4) el origen de las especies cultivadas de Capsicum. En cuanto a la biología reproductiva, para C. baccatum se pretende avanzar en el conocimiento de variables de relevancia en la reproducción, en especial los efectos del ambiente.

Estudio de la muerte celular por Apoptosis en el ovario de Columba maculosa y Columbina picui (Aves:Columbidae) durante el Ciclo Reproductivo Anual. Study of cell death by apoptosis in the ovary of Columba maculosa and Columbina picui (Aves: Columbidae) during the reproductive annual cycle.

En este trabajo se analizarán las características estructurales, cuantitativas y el proceso de muerte celular por apoptosis en el ovario de C. maculosa y C.picui con el objetivo de aportar conocimientos básicos a la biología reproductiva de estas aves. Cincuenta hembras adultas de cada especie se capturarán en el Dpto. Río Primero (Pcia. de Cba), R. Argentina, durante el ciclo reproductivo 2011-2012. Las muestras de ovarios se fijaran en Formalina Neutra pH 7.0, procesarán con la técnica de inclusión en parafina y colorearan con Hematoxilina /Eosina y Reacción Nuclear de Feulgen. Cinco muestras serán utilizadas para la determinación de muerte celular por apoptosis con la técnica de TUNEL. Se estudiarán las características morfohistológicas del ovario de C.maculosa y C. picui e identificarán, categorizarán y cuantificarán los folículos atrésicos no bursting (folículos atrésicos previtelogénicos y vcitelogénicos pequeños que conservan la integridad de la pared folicular) y bursting (folículos vitelogénicos mayores de 2 mm que liberar el contenido folicular por ruptura de la pared folicular) durante el ciclo reproductivo anual. Mediante la marcación de ADN fragmentado, se revelará la muerte celular por apoptosis en las células granulosas de los folículos atrésicos. Se compararán las semejanzas y diferencias estructurales y cuantitativas y el proceso de muerte celular en los folículos regresivos entre las dos especies. Los resultados de este trabajo representarán un importante aporte al conocimiento de la atresia folicular como así también a la muerte celular, un proceso estrechamente asociado a la misma, aún poco estudiado en el ovario de las aves. In this work we analyse the structural, quantitative and the process of the cell death by apoptosis in the ovary of Columba maculosa and Columbina picui in order of providing basic knowledge of reproductive biology of these birds. Fifty adult female of each species will be caught in the Río Primero (Pcia. Cba) R.Argentina, during 2011 - 2012. The ovarian samples will be fixed en neutral buffered Formalin (pH 7.0), processed with the technique of inclusion in paraffin and stained with Haematoxylin - Eosin, and nuclear Reaction of Feulgen. Five samples will be used to reveal cell death by apoptosis with the technique of TUNEL. Will be studied the morphohistological characteristics of ovary of both species, and identify, categorize and quantify the atretic follicles over the cycle, the non-bursting (pre-vitellogenic follicles and vitellogenic small < 2 mm, involution an without follicular rupture) and bursting (vitellogenic follicle > 2 mm in the which the yolk falls into the peritoneum due to rupture of with out put of the wall follicular). Will be revealed DNA fragmentation in the granulosa cells of the atretic follicles. Will compared the similaritues and differences in structure and quantitative and the cell death process by apoptosis in the regresive follicles, between the two species. The results of this study represent an important contribution to the knowledge of follicular atresia as well cell death a process closely associated with it and still poorly studied in the ovary of birds.

Estrategias reproductivas de lagartos del género tupinambis en distintos contextos ecológicos de la Provincia de Córdoba. Reproductive strategies of lizards of genus tupinambis in different ecological contexts of the Cordoba province.

Los caracteres de historia de vida son sensibles a la variación histórica o actual de los factores ambientales. Estudiar dicha variabilidad mediante la realización de estudios comparativos permite obtener evidencias sobre las causas de la evolución de ciertos caracteres. Los lagartos son excelentes modelos para el estudio de selección sexual y evolución del comportamiento social y reproductivo debido a que su relativa baja dispersión podría tener consecuencias evolutivas profundas en el desarrollo de distintas estrategias, ya que las poblaciones, al encontrarse más aisladas, podrían verse influenciadas por las fuerzas selectivas locales, mostrando una alta heterogeneidad espacial y temporal. Por eso nos propusimos realizar este trabajo para evaluar si existen diferentes estrategias reproductivas en los lagartos del género Tupinambis en distintos contextos ecológicos de la provincia de Córdoba. Para ello analizaremos distintas características de la historia de vida en poblaciones de estas especies tales como estructura de tamaño, sexo operativo, frecuencia reproductiva, tamaño de camada, condición corporal reproductiva, tamaño de madurez sexual, características espermáticas, elección de sitios de nidificación, etc. Además analizaremos la estructura genética de las poblaciones para inferir procesos demográficos históricos y patrones actuales de flujo génico y conectividad. The life history traits are sensitive to historical or current variation of environmental factors. Studying this variability by performing comparative studies allows obtaining evidence on the causes of the evolution of certain characters. Lizards are excellent models for studying sexual selection and evolution of social and reproductive behavior because their relatively low dispersal capabilities could have profound evolutionary consequences in the development of different strategies, since isolated populations may be stronger influenced by local selective forces, showing a high spatial and temporal heterogeneity. We decided to perform this study to assess whether there are different reproductive strategies in lizards of the genus Tupinambis in different ecological contexts of the Cordoba province. We will analyze different life history traits in populations of these species such as size structure, operational sex ratio, reproductive frequency, litter size, body condition, size at sexual maturity, sperm characteristics, choice of nesting sites, etc.. We also analyzed the genetic structure of populations to infer historical demographic processes and current patterns of gene flow and connectivity.

Age, growth and reproductive biology of whiting Merlangius merlangus (Linnaeus 1758) in the Celtic Sea

Age, growth and reproductive biology were investigated for whiting (Merlangius merlangus) captured from the Celtic Sea (ICES division Vllg), for the period January 2001 to January 2002. Females dominated the sex ratio of 1: 2.25. The relative abundance of females exceeded the number of males in all length classes. The relationship between weight (g) and total length (cm) was the same for male and female whiting. A total of 973 fish were aged and the maximum age recorded was 11 years. Results from an intercalibration exercise showed 87% agreement in age readings between the author and an expert in ageing whiting at the Marine Institute. Females were dominated by 2 year olds, while males were dominated by 3 year olds. Lx was estimated as 38cm and a growth rate was calculated K = 0.3769 year'1. Females were fully recruited to the fishery at 3 years of age, while the age at full recruitment (tr) for males was 4 years. Female whiting spawned from late February to June 2001 and matured at a total length of 23 cm in their first year. Female whiting reached L5o at a total length of 28 cm and 2.7 years of age. Male whiting spawned from February to June 2001. They matured at a total length of 21 cm and in their first year. Male whiting reached L50 at a total length of 30.4 cm and 3.6 years of age. The following critical points should be taken into account in the management of the Celtic Sea whiting stock: An Fpa should be established in order to assess the current level of fishing mortality; The maturity ogives need further study; The extent of gutting of large fish before landing by fishers in the fleet should be investigated and the apparent decline in size of 4 - 7 year old fish in the Celtic Sea between 1996 and 2001 needs to be assessed.

Age, growth and reproductive biology of Plaice, (Pleuronectes platessa L.) in Irish waters, 2003-2005

The current study presents data on age and growth for plaice (Pleuronectes platessa L.) sampled between November 2003 and February 2005 in ICES areas Via (northwest coast of Ireland), Vila (Irish Sea), Vllg (Celtic Sea), VDj (southwest coast of Ireland) and VHb (west coast of Ireland), and data on the reproductive biology and maturity of plaice in ICES area Vllb (west coast of Ireland). This is the first detailed account of the biology of plaice for some of these areas. It is intended that this study will improve understanding of the life cycle of plaice and help fisheries scientists to better predict the effect of fishing effort on Irish plaice stocks. The overall length range found for plaice was 9-51.99cm TL, with a length range of 9-5 lcm TL for females and 9-40cm for males. In all ICES areas the length range for female fish was larger than for male fish. The age range of plaice sampled during this study was 1 to 16 years. In all ICES areas females had a greater range in ages and fish in the larger age groups. From analysis of length and age data it was concluded that there was a significant difference (P=0.000) in growth rate of males and females between ICES areas sampled in March 2004. The highest rate of fishing mortality was determined for ICES area Via (F=1.06) and the lowest for ICES area Vila (F=0.56). In each ICES area male and female plaice have fully recruited to the population by age 4, with the exception of females in ICES area Via, for which a tr value of 5 years was determined. Length at first maturity (L50%) was determined to be 23cm and 21cm for males and females respectively. Age at first maturity (A50%) was determined to be 3 years for both males and females. It was found that males and females in ICES areas Vllb, Vila and Via are well above the length and age at first maturity when they are recruited to the fishery. In ICES area Vllb female plaice spawn from November to March, with peak spawning occurring in February, and male plaice spawn from November to April, with peak spawning occurring in November. Spawning females had an age range of 2 to 10 years and spawning males had an age range of 2 to 7 years. From the oocyte length frequency distributions, it was determined that the plaice is a determinate batch spawner. During this investigation a total of 177 ovaries and 127 testes were staged using both macroscopic and histological criteria. The overall percentage of maturity stages which compared favorably between the two assessment methods was 22.03% for female plaice and 37.80% for male plaice. In general, the findings of this study indicate that there was a very poor match between the macroscopic and histological assessment methods. Given that the histological determination of these stages is based on the observation of a distinct set of developmental features, it is expected that it would be more accurate to use histologically assessed gonads to calculate the annual percentage maturity assessment. The biology of plaice in the areas studied is compared with previous studies of plaice in Irish and European waters.