Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

INTRODUÇÃO: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O aces-so transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. MÉTODO: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clássica. RESULTADOS: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). CONCLUSÃO: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes.

LESION OF THE ANTEROVENTRAL 3RD VENTRICLE REGION IMPAIRS THE RECOVERY OF ARTERIAL-PRESSURE INDUCED BY HYPERTONIC SALINE IN RATS SUBMITTED TO HEMORRHAGIC-SHOCK

The effect of intravenous infusion of hypertonic saline (HS, 7.5% NaCl) on the recovery of mean arteria pressure (MAP) after hemorrhage was studied in sham-operated rats and in rats with electrolytic lesion of the anteroventral third ventricle (AV3V) region (4 h, 4 and 20 days). Rats anesthetized with thiopental sodium were bled (about 2.8 ml/100 g) until the MAP was stabilized at the level of 60 mmHg for 30 min. In sham-lesioned rats, MAP increased to 90 mmHg and became stable near this level after intravenous infusion of 7.5% NaCl (4 ml/kg b.wt.). In AV3V-lesioned rats, the same infusion induced a smaller increase in MAP (80 mmHg) and the MAP returned to pre-infusion levels within 30 min. These results show that the AV3V region plays an important role in the recovery of arterial pressure induced by hypertonic saline in rats submitted to hemorrhagic shock.

Neo-clerodane diterpenoid, a new metalloprotease snake venom inhibitor from Baccharis trimera (Asteraceae): anti-proteolytic and anti-hemorrhagic properties

Many plants are used in traditional medicine as active agents against various effects induced by snakebite. Few attempts have been made however to identify the nature of plain natural products with anti-ophidian properties. Baccharis trimera (Less) DC (Asteraceae), known in Brazil as carqueja. has been popularly used to treat liver diseases. rheumatism. diabetes, as well as digestive, hepatic and renal disorders. The active component was identified as 7alpha-hydroxy-3,13-clerodadiene-16,15:18,19-diolide, C20H28O5, (clerodane diterpenoid, Bt-CD). We report now the anti-proteolytic and anti-hemorrhagic propenies against snake venoms of a Bt-CD inhibitor from B. trimera. Bt-CD exhibited full inhibition of hemorrhage and proteolytic activity caused by Bothrops snake venoms. The inhibitor was able to neutralize the hemorrhagic, fibrinogenolytic and caseinolytic activities of class P-I and III metalloproteases isolated from B. neuwiedi and B. jararacussu venoms. No inhibition of the coagulant activity was observed. Bt-CD also partially inhibited the edema induced by other crude venoms, metallopronteases, basic and acidic phospholipases A(2). To further elucidate the inhibitory specificity of Bt-CD against metalloproteases isolated from snake venoms, a deeper understanding of its Structure and function is necessary. Furthermore, the potential use of these inhibitors to complement anti-venom as an alternative treatment of snakebite envenomations needs to be evaluated in future Studies. (C) 2004 Elsevier B.V.. All rights reserved.

Physiological and Stroke Parameters to Assess Aerobic Capacity in Swimming

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of gender on stroke rates, critical speed and velocity of a 30-min swim in young swimmers

Our objective was to analyze the effect of gender on the relationship between stroke rates corresponding to critical speed (SRCS) and maximal speed of 30 min (SRS30) in young swimmers. Twenty two males (GM1) (Age = 15.4 ± 2.1 yr., Body mass = 63.7 ± 12.9 kg, Stature = 1.73 ± 0.09 m) and fourteen female (GF) swimmers (Age = 15.1 ± 1.6 yr., Body mass = 58.3 ± 8.8 kg, Stature = 1.65 ± 0.06 m) were studied. A subset of males (GM2) was matched to the GF by their velocity for a 30 min swim (S30). The critical speed (CS) was determined through the slope of the linear regression line between the distances (200 and 400 m) and participant's respective times. CS was significantly higher than S30 in males (GM1 - 1.25 and 1.16 and GM2 - 1.21 and 1.12 m·s-1) and females (GF - 1.15 and 1.11 m·s-1). There was no significant difference between SRCS and SRS30 in males (GM1 - 34.16 and 32.32 and GM2 - 34.67 and 32.46 cycle·s-1, respectively) and females (GF - 34.18 and 33.67 cycle·s-1-1, respectively). There was a significant correlation between CS and S30 (GM1 - r = 0.89, GF - r = 0.94 and GM2 - r = 0.90) and between SRCS and SRS30 (GM1 - r = 0.89, GF - r = 0.80 and GM2 - r = 0.88). Thus, the relationship between SRCS and SRS30 is not influenced by gender, in swimmers with similar and different aerobic capacity levels. ©Journal of Sports Science and Medicine (2007).

Stroke phases responses around maximal lactate steady state in front crawl

The objective of this study was to analyze changes in stroke rate (SR), stroke length (SL) and stroke phases (entry and catch, pull, push and recovery) when swimming at (MLSS) and above (102.5% MLSS) the maximal lactate steady state. Twelve endurance swimmers (21±8 year, 1.77±0.10m and 71.6±7.7kg) performed in different days the following tests: (1) 200- and 400-m all-out tests, to determine critical speed (CS), and; (2) 2-4 30-min sub-maximal constant-speed tests, to determine the MLSS and 102.5% MLSS. There was significant difference among MLSS (1.22±0.05ms-1), 102.5% MLSS (1.25±0.04ms-1) and CS (1.30±0.08ms-1). SR and SL were maintained between the 10th and 30th minute of the test swum at MLSS and have modified significantly at 102.5% MLSS (SR - 30.9±3.4 and 32.2±3.5cyclesmin-1 and SL - 2.47±0.2 and 2.38±0.2mcycle-1, respectively). All stroke phases were maintained at 10th and 30th minute at MLSS. However, the relative duration of propulsive phase B (pull) increased significantly at 102.5% MLSS (21.7±3.4% and 22.9±3.9%, respectively). Therefore, the metabolic condition may influence the stroke parameters (SR and SL) and stroke strategy to maintain the speed during swim tests lasting 30min. © 2010 Sports Medicine Australia.

Trochlear nerve palsy associated with claude bernard-horner syndrome after brainstem stroke

The association of unilateral trochlear nerve palsy with Claude Bernard-Horner syndrome represents a rare clinical condition. We present the case of a patient with this unusual presentation. The investigation performed implicated cerebrovascular disease as the underlying cause of the condition in this patient. © 2011 S. Karger AG, Basel.