Imagerie de la valve aortique en CT.

Messages à retenir: Le scanner peut aider au diagnostic et la caractérisation des valvulopathies et des lésions associées (aorte, coronaires). Le scanner est un examen incontournable pour l'évaluation pré-thérapeutique des procédures TAVI (transfémorale ou transapicale). Le scanner peut être utile pour caractériser les insuffisances aortiques. Grâce aux développements récents dans les thérapies peu invasives et au progrès du CT, le rôle du radiologue est redevenu central dans la prise en charge de certaines valvulopathies aortiques. Résumé: Les valvulopathies aortiques sont des maladies fréquentes. Leur exploration repose largement sur l'échocardiographie et sur l'IRM. Les progrès technologiques en scanner cardiaque ont permis à ce dernier d'explorer la valve aortique et ses pathologies. Ce cours est principalement consacré aux méthodes d'acquisition et de traitement des images dédiées à l'exploration de la valve aortique (plan de coupes, planimétrie, scores...). Une attention particulière est réservée aux considérations anatomiques spécifiques à celle-ci (variantes anatomiques). Les indications du scanner cardiaque dans les valvulopathies seront résumées (sténoses, insuffisances, pathologie tumorale et pathologies inflammatoires). Dans la sténose de la valve, outre ses performances diagnostiques, le scanner plus ou moins couplé à l'exploration des vaisseaux périphériques, est devenu une méthode intournable dans le bilan pré-thérapeutique. La connaissance des paramètres à évaluer (taille de l'anneau, position des coronaires, orientation du plan de la valve...) et la standardisation des mesures sont un élément clé pour une prise en charge optimale. Dans les insuffisances aortiques, les méthodes de quantification (planimétrie) peuvent être utilisées pour les caractériser avec des performances comparables à celles obtenues par d'autres techniques.

Simbiose de bactérias fixadoras de nitrogênio com feijoeiro-comum em diferentes valores de pH

O objetivo deste trabalho foi avaliar o efeito do pH do meio de cultivo na eficiência simbiótica de estirpes de Rhizobium, em solo com e sem calagem. Foram realizados experimentos em casa de vegetação, com e sem calagem, e no campo, apenas com calagem. O delineamento experimental utilizado foi de blocos ao acaso com quatro repetições, e os tratamentos foram cinco estirpes de Rhizobium (UFLA 02-100, UFLA 02-68, UFLA 04-195, UFLA 04-202 e CIAT 899), cultivadas em meio de cultura 79 com diferentes valores de pH (5,0, 6,0 e 6,9), e testemunhas sem inoculação, com ou sem nitrogênio mineral. Foram avaliados número e massa de matéria seca de nódulos, massa de matéria seca da parte aérea, eficiência relativa, teor e acúmulo de nitrogênio na parte aérea e nos grãos, número de vagens por planta, número de grãos por vagem e rendimento e massa de 100 grãos. O valor de pH ideal para o meio de cultivo variou com as estirpes e com a variável analisada. Os tratamentos que receberam calagem foram superiores aos demais. No campo, independentemente do pH do inoculante, as populações nativas do solo e as estirpes introduzidas promoveram rendimento de grãos semelhante ao da testemunha com 70 kg ha-1 de N e ao da estirpe referência CIAT 899.

Cambios de color y pH causados por el PVAc en bienes culturales

Este artículo presenta los primeros resultados del estudio "Identificación de patologías causadas por el PVAc en bienes culturales" que se está realizando en la Sección de Conservación-Restauración de la Facultad de Bellas Artes, Universidad de Barcelona. El trabajo se basa en el estudio de obras originales que fueron tratadas con PVAc en los años 70-80 y pretende identificar los problemas que genera el PVAc en materiales de archivo, arqueológicos, pintura sobre tela, sobre madera y pintura mural. Tras el análisis de las obras originales, se han preparado muestras probeta que reproducen sus características, así como de adhesivos de PVAc comerciales y de uso específico en restauración. Éstas han sido analizadas antes y después de someterlas a dos fases consecutivas de envejecimiento acelerado. También se han analizado obras originales con PVAc aplicado hace aproximadamente 30 años. El artículo presenta los resultados de las mediciones de color y pH en las muestras probeta antes y después de la primera fase de envejecimiento acelerado y, también, en las muestras envejecidas de forma natural durante 10 años.

A study of the effects of PVAC on works of art on paper and wood: pH and colour change

This paper presents the preliminary findings of pH and colour measurements carried out on artworks on paperand on wood that had been treated with a poly(vinyl acetate) (PVAC) based adhesive in the 1980s. In both cases, areas treated with PVAC proved to be less acidic than untreated areas. Contrary to expectations, the conservation treatments have not, as yet, increased acidity levels in the objects under study. Colour measurements of the works on paper showed that those that had been backed with a cotton fabric using a mixture of methylcellulose and PVAC were less yellow than those from the same print run that had not been backed. This finding suggests that the backing somehow prevented the natural degradation of the support. In view of these preliminary results, further research is clearly needed. This study forms part of a broader ongoing project to assess the role of PVAC in the conservation of a range of cultural assets.

Cambios de color y pH causados por el PVAc en bienes culturales

Este artículo presenta los primeros resultados del estudio "Identificación de patologías causadas por el PVAc en bienes culturales" que se está realizando en la Sección de Conservación-Restauración de la Facultad de Bellas Artes, Universidad de Barcelona. El trabajo se basa en el estudio de obras originales que fueron tratadas con PVAc en los años 70-80 y pretende identificar los problemas que genera el PVAc en materiales de archivo, arqueológicos, pintura sobre tela, sobre madera y pintura mural. Tras el análisis de las obras originales, se han preparado muestras probeta que reproducen sus características, así como de adhesivos de PVAc comerciales y de uso específico en restauración. Éstas han sido analizadas antes y después de someterlas a dos fases consecutivas de envejecimiento acelerado. También se han analizado obras originales con PVAc aplicado hace aproximadamente 30 años. El artículo presenta los resultados de las mediciones de color y pH en las muestras probeta antes y después de la primera fase de envejecimiento acelerado y, también, en las muestras envejecidas de forma natural durante 10 años.

A study of the effects of PVAC on works of art on paper and wood: pH and colour change

This paper presents the preliminary findings of pH and colour measurements carried out on artworks on paperand on wood that had been treated with a poly(vinyl acetate) (PVAC) based adhesive in the 1980s. In both cases, areas treated with PVAC proved to be less acidic than untreated areas. Contrary to expectations, the conservation treatments have not, as yet, increased acidity levels in the objects under study. Colour measurements of the works on paper showed that those that had been backed with a cotton fabric using a mixture of methylcellulose and PVAC were less yellow than those from the same print run that had not been backed. This finding suggests that the backing somehow prevented the natural degradation of the support. In view of these preliminary results, further research is clearly needed. This study forms part of a broader ongoing project to assess the role of PVAC in the conservation of a range of cultural assets.

Identification of novel secreted proteases during extracellular proteolysis by dermatophytes at acidic pH.

The dermatophytes are a group of closely related fungi which are responsible for the great majority of superficial mycoses in humans and animals. Among various potential virulence factors, their secreted proteolytic activity attracts a lot of attention. Most dermatophyte-secreted proteases which have so far been isolated in vitro are neutral or alkaline enzymes. However, inspection of the recently decoded dermatophyte genomes revealed many other hypothetical secreted proteases, in particular acidic proteases similar to those characterized in Aspergillus spp. The validation of such genome predictions instigated the present study on two dermatophyte species, Microsporum canis and Arthroderma benhamiae. Both fungi were found to grow well in a protein medium at acidic pH, accompanied by extracellular proteolysis. Shotgun MS analysis of secreted protein revealed fundamentally different protease profiles during fungal growth in acidic versus neutral pH conditions. Most notably, novel dermatophyte-secreted proteases were identified at acidic pH such as pepsins, sedolisins and acidic carboxypeptidases. Therefore, our results not only support genome predictions, but demonstrate for the first time the secretion of acidic proteases by dermatophytes. Our findings also suggest the existence of different pathways of protein degradation into amino acids and short peptides in these highly specialized pathogenic fungi.

Prevention and management of potential adverse events during transapical aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: Transapical transcatheter aortic valve replacement (TAVR) is a new minimally invasive technique with a known risk of unexpected intra-procedural complications. Nevertheless, the clinical results are good and the limited amount of procedural adverse events confirms the usefulness of a synergistic surgical/anesthesiological management in case of unexpected emergencies. METHODS: A review was made of the authors' four-year database and other available literature to identify major and minor intra-procedural complications occurring during transapical TAVR procedures. All implants were performed under general anesthesia with a balloon-expandable Edwards Sapien stent-valve, and followed international guidelines on indications and techniques. RESULTS: Procedural success rates ranged between 94% and 100%. Life-threatening apical bleeding occurred very rarely (0-5%), and its incidence decreased after the first series of implants. Stent-valve embolization was also rare, with a global incidence ranging from 0-2%, with evidence of improvement after the learning curve. Rates of valve malpositioning ranged from 0% to < 3%, whereas the risk of coronary obstruction ranged from 0% to 3.5%. Aortic root rupture and dissection were dramatic events reported in 0-2% of transapical cases. Stent-valve malfunction was rarely reported (1-2%), whereas the valve-in-valve bailout procedure for malpositioning, malfunctioning or severe paravalvular leak was reported in about 1.0-3.5% of cases. Sudden hemodynamic management and bailout procedures such as valve-in-valve rescue or cannulation for cardiopulmonary bypass were more effective when planned during the preoperative phase. CONCLUSION: Despite attempts to avoid pitfalls, complications during transapical aortic valve procedures still occur. Preoperative strategic planning, including hemodynamic status management, alternative cannulation sites and bailout procedures, are highly recommended, particularly during the learning curve of this technique.

Wireless capsule pH monitoring: does it fulfil all expectations?

pH monitoring has been used as a diagnostic tool in gastro-oesophageal reflux disease (GERD) for many years. Recent studies have shown that wireless capsule pH monitoring is better tolerated and interferes less with daily activities as compared to traditional catheter-based pH monitoring. Moreover, prolonged recording time (48 h instead of 24 h) is possible with wireless pH monitoring. The main secondary effect of wireless capsule pH monitoring is induction of thoracic discomfort in 10-65% of the patients, which can vary from mild foreign body sensation to severe chest pain. Sensitivity and specificity of wireless capsule monitoring is comparable to that of traditional pH monitoring. It has not been proven yet that better tolerability and a longer recording time increases the diagnostic yield of wireless capsule monitoring in GERD.

Neonatal lupus erythematosus with congenital heart block and severe heart failure due to myocarditis and endocardititis of the mitral valve.

We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.