Jules Laforgue e Carlos Drummond de Andrade: a ironia e a construção do gauche

Pós-graduação em Estudos Literários - FCLAR

Left atrial myxoma attached to the anterior mitral leaflet with symptoms suggestive of infective endocarditis

The case of a 55-year-old woman is presented, whose clinical signs were initially suggestive of infective endocarditis. Transthoracic echocardiography (TTE) provided the diagnosis of a large left atrial myxoma attached to the anterior mitral leaflet. Perioperative transesophageal echocardiography (TEE) confirmed preoperative findings and assisted the surgical team in the assessment of tumour size, area of attachment, and mobility. Following tumour resection, TEE demonstrated residual moderate mitral valve regurgitation, which resulted in a change of surgical strategy. This report reinforces the importance of intraoperative TEE to facilitate and optimize surgical and anaesthesiological management of patients presenting with non-specific cardiorespiratory symptoms.

Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism

In haemodynamically stable patients with acute symptomatic pulmonary embolism (PE), studies have not evaluated the usefulness of combining the measurement of cardiac troponin, transthoracic echocardiogram (TTE), and lower extremity complete compression ultrasound (CCUS) testing for predicting the risk of PE-related death.

Noninvasive Doppler-derived myocardial performance index in rats with myocardial infarction: validation and correlation by conductance catheter

The rodent model of myocardial infarction (MI) is extensively used in heart failure studies. However, long-term follow-up of echocardiographic left ventricular (LV) function parameters such as the myocardial performance index (MPI) and its ratio with the fractional shortening (LVFS/MPI) has not been validated in conjunction with invasive indexes, such as those derived from the conductance catheter (CC). Sprague-Dawley rats with left anterior descending coronary artery ligation (MI group, n = 9) were compared with a sham-operated control group (n = 10) without MI. Transthoracic echocardiography (TTE) was performed every 2 wk over an 8-wk period, after which classic TTE parameters, especially MPI and LVFS/MPI, were compared with invasive indexes obtained by using a CC. Serial TTE data showed significant alterations in the majority of the noninvasive functional and structural parameters (classic and novel) studied in the presence of MI. Both MPI and LVFS/MPI significantly (P < 0.05 for all reported values) correlated with body weight (r = -0.58 and 0.76 for MPI and LVFS/MPI, respectively), preload recruitable stroke work (r = -0.61 and 0.63), LV end-diastolic pressure (LVEDP) (r = 0.82 and -0.80), end-diastolic volume (r = 0.61 and -0.58), and end-systolic volume (r = 0.46 and -0.48). Forward stepwise linear regression analysis revealed that, of all variables tested, LVEDP was the only independent determinant of MPI (r = 0.84) and LVFS/MPI (r = 0.83). We conclude that MPI and LVFS/MPI correlate strongly and better than the classic noninvasive TTE parameters with established, invasively assessed indexes of contractility, preload, and volumetry. These findings support the use of these two new noninvasive indexes for long-term analysis of the post-MI LV remodeling.

Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

BACKGROUND -The value of standard two-dimensional transthoracic echocardiographic (TTE) parameters for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is controversial. METHODS AND RESULTS -We investigated the impact of right ventricular fractional area change (FAC) and tricuspid annulus plane systolic excursion (TAPSE) for prediction of major adverse cardiovascular events (MACE) defined as the occurrence of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia or arrhythmogenic syncope. Among 70 patients who fulfilled the 2010 ARVC/D Task Force Criteria and underwent baseline TTE, 37 (53%) patients experienced a MACE during a median follow-up period of 5.3 (IQR 1.8-9.8) years. Average values for FAC, TAPSE, and TAPSE indexed to body surface area (BSA) decreased over time (p=0.03 for FAC, p=0.03 for TAPSE and p=0.01 for TAPSE/BSA, each vs. baseline). In contrast, median right ventricular end-diastolic area (RVEDA) increased (p=0.001 vs. baseline). Based on the results of Kaplan-Meier estimates, the time between baseline TTE and experiencing MACE was significantly shorter for patients with FAC <23% (p<0.001), TAPSE <17mm (p=0.02) or right atrial (RA) short axis/BSA ≥25mm/m(2) (p=0.04) at baseline. A reduced FAC constituted the strongest predictor of MACE (hazard ratio 1.08 per 1% decrease; 95% confidence interval 1.04-1.12; p<0.001) on bivariable analysis. CONCLUSIONS -This long-term observational study indicates that TAPSE and dilation of right-sided cardiac chambers are associated with an increased risk for MACE in ARVC/D patients with advanced disease and a high risk for adverse events. However, FAC is the strongest echocardiographic predictor of adverse outcome in these patients. Our data advocate a role for TTE in risk stratification in patients with ARVC/D, although our results may not be generalizable to lower risk ARVC/D cohorts.

Assessment of low-flow, low-gradient, severe aortic stenosis: an invasive evaluation is required for decision making.

Low-flow, low-gradient severe aortic stenosis (AS) is characterised by a small aortic valve area (AVA) and low mean gradient (MG) secondary to a low cardiac output and may occur in patients with either a preserved or reduced left ventricular ejection fraction (LVEF). Symptomatic patients presenting with low-flow, low-gradient severe AS have a dismal prognosis independent of baseline LVEF if managed conservatively and should therefore undergo aortic valve replacement if feasible. Transthoracic echocardiography (TTE) is the first-line investigation for the assessment of AS haemodynamic severity. However, when confronted with guideline-discordant AVA (small) and MG (low) values, there are several reasons other than severe AS combined with a low cardiac output which may lead to such a situation, including erroneous measurements, small body size, inherent inconsistencies in the guidelines' criteria, prolonged ejection time and aortic pseudostenosis. The distinction between these various entities poses a diagnostic challenge. However, it is important to make a distinction because each has very different implications in terms of risk stratification and therapeutic management. In such instances, cardiac catheterisation forms an integral part of the work-up of these patients in order to confirm or refute the echocardiographic findings to guide management decisions appropriately.

Clinical role of atrial arrhythmias in patients with arrhythmogenic right ventricular dysplasia

BACKGROUND: The clinical role of atrial fibrillation/atrial flutter (AF-AFl) and variables predicting these arrhythmias are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). We hypothesized that transthoracic echocardiography (TTE) and 12-lead electrocardiography (ECG) would be helpful in predicting AF-AFl in these patients. METHODS AND RESULTS: ECGs and TTEs of 90 patients diagnosed with definite or borderline ARVD (2010 Task Force Criteria) were analyzed. Data were compared in (1) patients with AF-AFl and (2) all other patients. A total of 18 (20%) patients experienced AF-AFl during a median follow-up of 5.8 years (interquartile range 2.0-10.4). Kaplan-Meier analysis revealed reduced times to AF-AFl among patients with echocardiographic RV fractional area change <27% (P<0.001), left atrial diameter ≥24.4 mm/m(2)(parasternal long-axis, P=0.001), and right atrial short-axis diameter ≥22.1 mm/m(2)(apical 4-chamber view, P=0.05). From all ECG variables, P mitrale conferred the highest hazard ratio (3.37, 95% confidence interval 0.92-12.36, P=0.067). Five patients with AF-AFl experienced inappropriate implantable cardioverter-defibrillator (ICD) shocks compared with 4 without AF-AFl (36% vs. 9%, P=0.03). AF-AFl was more prevalent in heart-transplant patients and those who died of cardiac causes (56% vs. 16%, P=0.014). CONCLUSIONS: AF-AFl is associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Evidence of reduced RV function and atrial dilation helps to identify the ARVD patients at increased risk for AF-AFl.

Thrombus formation in the left ventricle after large myocardial infarction – assessment with cardiac magnetic resonance imaging

INTRODUCTION Left ventricular thrombus (LVT) formation may worsen the post-infarct outcome as a result of thromboembolic events. It also complicates the use of modern antiplatelet regimens, which are not compatible with long-term oral anticoagulation. The knowledge of the incidence of LVT may therefore be of importance to guide antiplatelet and antithrombotic therapy after acute myocardial infarction (AMI). METHODS In 177 patients with large, mainly anterior AMI, standard cardiac magnetic resonance imaging (CMR) including cine and late gadolinium enhancement (LGE) imaging was performed shortly after AMI as per protocol. CMR images were analysed at an independent core laboratory blinded to the clinical data. Transthoracic echocardiography (TTE) was not mandatory for the trial, but was performed in 64% of the cases following standard of care. In a logistic model, 3 out of 61 parameters were used in a multivariable model to predict LVT. RESULTS LVT was detected by use of CMR in 6.2% (95% confidence interval [CI] 3.1%-10.8%). LGE sequences were best to detect LVT, which may be missed in cine sequences. We identified body mass index (odds ratio 1.18; p = 0.01), baseline platelet count (odds ratio 1.01, p = 0.01) and infarct size as assessed by use of CMR (odds ratio 1.03, p = 0.02) as best predictors for LVT. The agreement between TTE and CMR for the detection of LVT is substantial (kappa = 0.70). DISCUSSION In the current analysis, the incidence of LVT shortly after AMI is relatively low, even in a patient population at high risk. An optimal modality for LVT detection is LGE-CMR but TTE has an acceptable accuracy when LGE-CMR is not available.

Der Physiologus und das Neue Testament. Die neutestamentlichen Wurzeln der frühchristlichen Naturallegorese

Der Beitrag untersucht die hermeneutische Methode des griechischen Physiologus, die bereits Pitra (1855) in seiner kritischen Edition als Allegorie bzw. Allegorese bezeichnete, und zeigt die neutestamentlichen Wurzeln dieser ersten christlichen Naturallegorese auf. Denn im Physiologus handelt es sich um keine Allegorie im klassischen Sinne, sondern um ihre genuin christliche Form. Diese kennt man zwar vor allem aus den Werken des Klemens von Alexandrien und Origenes, ihre Grundlagen wurden aber schon von Paulus und Johannes im Neuen Testament gelegt. Auch im Physiologus dient der Christus als hermeneutischer Schlüssel, die Stelle des Alten Testamentes nimmt allerdings die ‹Natur› ein, die allegorisch gedeutet und umgeschrieben wird: «So sollen auch die vollkommenen Christenmenschen die Worte des Alten Testamentes vom Geist unterscheiden, damit dich nicht etwa der Buchstabe töte. Denn Paulus hat gesagt: ‹Das Gesetz ist geistlich›» [Physiologus 12, Von der Ameise; Röm 7,14; 2 Kor 3,6].

Geochemistry data from the Toupugol volcanogenic complex

A large fragment of a paleovolcano of Silurian to Early Devonian age was discovered in the Voikar volcanic belt suggesting an ensimatic island are as its geodynamic environment. Formationally, the rocks under study are comparable to Pleistocene island arc volcanites and their paleo-analogues. The volcanites of the Toupugol complex underwent strong hydrothermal-metasomatic alteration: propylites, acid metasomatic rocks and quartz-carbonate veins, which must have resulted from hydrothermal-metasomatic alteration of andesitoids. Both volcanites and apovolcanic hydrothermal rocks in Toupugol were found to host noble metal mineralisation. It is found in close association with sulphides, particularly pyrite. Free gold was discovered in all investigated volcanites and hydrothermal rocks and is characterised by low mercury content and an unusual set of microimpurities (Pt, Pd, Cu, Fe, S) suggesting its links to the mantle substrate.

III. Sermon notes, 1746-1747

This paper notebook contains abstracts of sermons attended between January 12, 1745/6 and November 15, 1747 in Kingston, Massachusetts, presumably by William Sever. The notebook lists the minister by last name, the location ("King." for Kingston), the date the sermon was delivered, the biblical passage used, and one-to-two-page entries on the sermon containing numbered notes and a section titled "Improvements and Applications." From the front of the volume, the pages contain entries for sermons attended between January 12 1745/6 through November 30, 1746, and there are no entries for June-September 1746. Sermon entries for December 7, 1746 to November 15, 1747 are written tête-bêche from the other end of the volume, and there are no entries for February-July 1747. Almost all of the sermons were delivered by Rev. William Rand, but there are sporadic sermons by additional ministers, who based on the last name are presumed to be John Angier (1701-1787; Harvard AB 1720), Ebenezer Gay (1696-1787; Harvard AB 1714), Nathaniel Eells (1678-1750; Harvard AB 1699), Josiah Torrey (1720-1783; Harvard AB 1741) and Daniel Shute (1722-1802; Harvard AB 1743).

Volume I, original,

This volume is a tête-bêche, with texts beginning at both the front and back covers rotated 180⁰ from one another. The portion at the back, which is much shorter in length, contains transcriptions of acts and orders of the General Court from 1642, 1650, and 1657. It also contains the "Rules and Statutes Relating to the Hollis Professorship of Divinity" and those relating to the Hollis Professorship of Mathematics and Natural and Experimental Philosophy, as well as a transcription of a portion of Mary Saltonstall's will.

Quarterly account book, 1722-1751

The quarterly accounts are held in one tall folio volume spanning the years 1722-1751. The volume contains three sections: a journal of quarterly accounts tallying money owed to the Butler by students and tutors, followed by a journal of purchases made by the Butler, and finally, written tête-bêche (from the back cover forward), a ledger with weekly calculations and final quarterly sums owed the Butler by students and tutors.

Some account of a paper call'd the Telltale, begun in colledge Sept 1721

The small leather-bound volume holds two sections, a manuscript student periodical, and written tête-bêche, an exchange on smallpox inoculation followed by notes on the rules and activities of a Harvard College student club. The volume begins with thirteen numbered manuscript issues, written in one hand, of the Tell-Tale running from September 9, 1721 to November 1, 1721. Prefaced, "This paper was entitl'd the Telltale or Criticisms on the Conversation & Beheavour of Scholars to promote right reasoning & good manner," the work is modeled after literary periodicals of the time, including the "Spectator," and is considered the oldest student publication at Harvard. The periodical appears to have circulated in manuscript form. The content varies in format and includes letters between Telltale and correspondents, short essays, and advertisements. Topics discussed include conversation, detraction, and flattery. While not specifically about Harvard it does provide some information about the College including evidence of various student activities and organizations at Harvard in the 1720s. The entry explaining the rules of the Telltale Club is heavily faded and nearly illegible. The Telltale records multiple dreams, which are populated by various characters, such as “beautiful” Kate, two “learned Physicians” debating inoculation, “four Fellows” “pushing and shoving one another,” and a “person of a very Dark & swarthy complexion in a Slovenly Dress with 7 patches & 5 sparks on his Face.”

Commonplace book of Nathaniel Freeman, 1786-1787

Nathaniel Freeman made entries in this commonplace book between 1786 and 1787, while he was an undergraduate at Harvard College. The book includes the notes Freeman took during three of Hollis Professor Samuel Williams' "Course of Experimental Lectures," and cover Williams' lectures on "The Nature & Properties of Matter," "Attraction & Repulsion," and "The Nature, Kind, & Affections [?] of Motion." These notes also include one diagram. The book also includes forensic compositions on the subjects of capital punishment, the probability of "the immortality of the soul," and "whether there be any disinterested benevolence." It also includes a poem Freeman composed for his uncle, Edmund Freeman; an anecdote about Philojocus and Gripus; an essay called "Character"; a draft of a letter to the Harvard Corporation requesting that, in light of the public debt, the Commencement ceremonies be held privately to lower expenses and exhibit the merits of economy; and an "epistle" to his father, requesting money. This epistle begins: "Most honored sire, / Thy son, poor Nat, in humble strains, / Impell'd by want, thy generous bounty claims."