Avaliação ecocardiográfica de pacientes submetidos à cirurgia mitral com papilopexia cruzada

FUNDAMENTO: As técnicas de substituição mitral com preservação do aparelho subvalvar têm reafirmado sua superioridade, sendo a papilopexia cruzada uma nova opção técnica que além de permitir preservação de estruturas anatômicas, oferece suporte na contração e protege o miocárdio na diástole ventricular, necessitando de estudos que documentem seus resultados. OBJETIVO: Avaliar as funções atrial e ventricular esquerdas, através de ecodopplercardiografia, em pacientes submetidos à substituição da valva mitral com papilopexia cruzada. MÉTODOS: Foram submetidos à substituição valvar mitral 15 pacientes, sendo nove (60%) do sexo masculino, com idade média de 45,7 anos. Quanto à etiologia, nove (60%) casos eram degenerativos, três (20%) reumáticos, dois (13,3%) isquêmicos e um (6,7%) com endocardite infecciosa. Após atriotomia e avaliação anatômica do aparelho valvar o folheto anterior foi desinserido do anel e centralmente dividido, sendo cada metade com seu complexo de cordas tendíneas fixada à comissura oposta por sua extremidade medial. Foi Implantada a prótese valvar biológica (em 13 casos) ou mecânica, fixada por pontos separados, com redução do anel valvar nos casos com miocardiopatia dilatada. Foram tomadas avaliações clinicas e ecodopplercardiográficas no pré-operatório, e sexto mês de pós-operatório. RESULTADOS: Todos os pacientes receberam alta em condições clínicas estáveis. Foi demonstrada redução significativa dos diâmetros ventriculares e dos diâmetros atriais (p< 0,001) sem comprometimento das vias de entrada e saída do ventrículo esquerdo. CONCLUSÃO: As substituições da valva mitral realizadas com a técnica de papilopexia cruzada apresentaram resultados favoráveis, com efeito positivo na recuperação morfológica atrial e ventricular esquerdas.

Rosiglitazona e lesão vascular em coelhos hipercolesterolêmicos: avaliação da formação neointimal

FUNDAMENTO: O uso da rosiglitazona tem sido o objeto de extensas discussões. OBJETIVO: Avaliar os efeitos da rosiglitazona nas artérias ilíacas, no local da injúria e na artéria contralateral, de coelhos hipercolesterolêmicos submetidos à lesão por cateter-balão. MÉTODOS: Coelhos brancos machos receberam uma dieta hipercolesterolêmica através de gavagem oral por 6 semanas e foram divididos em 2 grupos: grupo rosiglitazona (GR - 14 coelhos tratados com rosiglitazona por 6 semanas) e grupo controle (GC - 18 coelhos sem rosiglitazona). Os animais foram submetidos a lesão por cateter-balão na artéria ilíaca direita no 14º dia. RESULTADOS: Na artéria ilíaca contralateral, não houve diferença significante na razão entre as áreas intimal e medial (RIM) entre os grupos GR e GC. A rosiglitazona não reduziu a probabilidade de lesões tipo I, II ou III (72,73% vs 92,31%; p=0,30) e lesões tipo IV ou V (27,27% vs 7,69%; p=0,30). Na artéria ilíaca homolateral, a área intimal era significantemente menor no GR quando comparado ao GC (p = 0,024). A área luminal era maior no GR quando comparado ao GC (p < 0,0001). Houve uma redução significante de 65% na IMR no GR quando comparado ao GC (p = 0,021). Nenhum dos critérios histológicos para lesões ateroscleróticas tipos I a V (American Heart Association) foram encontrados na artéria ilíaca homolateral. CONCLUSÃO: Esses achados demonstram que a administração de rosiglitazona por 6 semanas impede a aterogênese no local da lesão, mas não em um vaso distante do sítio da lesão.

Resveratrol provoca efeitos antiaterogênicos em um modelo animal de aterosclerose

FUNDAMENTO: O resveratrol protege o sistema cardiovascular por meio de uma série de mecanismos, incluindo atividades antioxidantes e antiplaquetárias. OBJETIVO: Avaliar os possíveis efeitos anti-inflamatórios e antiaterogênicos do resveratrol, utilizando coelhos alimentados com uma dieta hipercolesterolêmica (1% de colesterol). MÉTODOS: Vinte coelhos brancos adultos do sexo masculino foram selecionados e divididos em dois grupos: grupo controle (GC), 10 coelhos; e grupo resveratrol (GR), 10 coelhos. Os animais foram alimentados com uma dieta hipercolesterolêmica por 56 dias. Para a dieta do GR, o resveratrol (2mg/kg peso/dia) foi adicionado do 33º ao 56º dia. RESULTADOS: Não houve diferença significativa entre os grupos no colesterol sérico total, no colesterol HDL, no colesterol LDL e nos triglicerídeos. No GC, 70% apresentaram lesões ateroscleróticas avançadas da aorta (tipos III, IV, V ou VI). Todos os animais do GR apresentaram lesões ateroscleróticas leves da aorta (tipos I ou II) ou não apresentaram lesões. A razão entre a área intimal e a área da camada intimal/medial mostrou-se significativamente menor no GR quando comparada ao GC (p < 0,001). Áreas positivas para moléculas de adesão celular vascular-1 (VCAM-1) foram menores no GR (p = 0,007). As concentrações de proteína quimiotática de monócitos-1 (MCP-1) e de interleucina-6 (IL-6) mostraram-se significativamente menores no GR do que no GC (p = 0,039 e p = 0,015, respectivamente). CONCLUSÃO: O Resveratrol apresentou importantes efeitos antiaterogênicos e anti-inflamatórios em um modelo animal com coelhos alimentados com uma dieta hipercolesterolêmica.

Möglichkeiten und Grenzen des Distance Learning am Beispiel des Alberta Distance Learning Centre in Kanada : Analyse und Transfer auf den Schulkontext Sachsen-Anhalts

Distance learning, Canadian educational system, institution, medial learning, school system Saxony-Anhalt, system theory, qualitative research

Um novo gênero e espécie de Baetidae (Ephemeroptera) do Estado de Minas Gerais Sudeste do Brasil

Iguaira gen. nov., type species, I. poranga, sp. nov., based on one nymph from the State of Minas Gerais, Brazil, are proposed. The new taxon is distinguished by the labrum with multiple, unorganized setae dorsally; hypopharynx with three-lobed lingua; cleft mandibular incisors; labium with internally curved paraglossae; labial palps with second segment with strong, apically rounded distomedial process and third segment with truncate medial and apical margins; elongate tarsal claws with minute denticles; and absence of scales and scale bases.

Sewage impact on the composition and distribution of Polychaeta associated to intertidal mussel beds of the Mar del Plata rocky shore, Argentina

The polychaete composition and distribution within mussel beds were studied in order to assess organic pollution due to domestic sewage in a rocky shore of Mar del Plata (Argentina) during 1997. Four stations and a control site were randomly sampled around the local effluent. Quantitative data on polychaetes, as well as sediment accumulated among mussels and its organic carbon content were measured. Polychaete distribution patterns are related to the organic matter gradient, being Capitella cf. capitata, Neanthes succinea (Frey & Leuckart, 1847) and Boccardia polybranchia (Haswell, 1885) the dominant indicator species close to the effluent. At medial distances, the cirratulids Caulleriella alata (Southern, 1914) and Cirratulus cirratus (Müller, 1776) are very important in abundance. The syllids Syllis prolixa Ehlers, 1901 and S. gracilis Grube, 1840 are distributed along the study area, but dominate at the medial stations and at the control site. The orbiniid Protoariciella uncinata Hartmann-Schröder, 1962 is subdominant at the control station.

The tadpole of Hypsiboas atlanticus (Anura, Hylidae) from northeastern Brazil

The tadpole of Hypsiboas atlanticus (Caramaschi & Velosa, 1996) is described from the municipality of Maceió, State of Alagoas, Brazil. At stage 36 the larvae have an overall elliptical body in lateral and dorsal views, oral disc anteroventral, spiracular tube sinistral, and labial tooth row formula 2(1,2)/3(1). The oral disc is surrounded, almost completely (anterior medial gap present) by a single row of marginal papillae. Described tadpoles of the H. punctatus species group can be differentiated by a combined disc oral features. Additional descriptions of H. punctatus (Schneider, 1799) tadpoles from populations throughout South America may be helpful in determining the status of these populations.

Estructura del aparato reproductor masculino de Uca uruguayensis (Decapoda, Ocypodidae)

The structure of the male reproductive tract was described in Uca uruguayensis Nobili, 1901, by using histological methods, scanning electron microscopy techniques, and stereoscopic observations of fresh material. The aim of this work was to establish the functional changes associated with sexual maturation. The morphology of the first (G1) and second (G2) pair of gonopods was described. The male reproductive tract consists of paired organs: testes, and tubular and convoluted vas deferens (VD) ending with a terminal ampoule (TA).The (VD) is composed of three parts: anterior (AVD), medial (MVD) and posterior (PVD). The AVD and MVD are lined by a single layer of cubical cells. The PVD epithelial cells are columnar with elongated nuclei. The terminal ampoule comprises four interconnecting chambers and is externally surrounded by connective tissue. The study of testes and vas deferens at different times along the year suggests that U. uruguayensis has a single and continuous reproductive season from December to March. The TA has not been described in other brachyurans and this structure is novel to Brachyura.

Osteological alterations in the tucuxi Sotalia fluviatilis (cetacea, delphinidae)

We present a description of osteological alterations observed in the tucuxi, Sotalia fluviatilis (Gervais, 1853) from a sample of 43 specimens. Fractures were the most frequent alterations in the sample (16%), occurring in various regions of the skeleton such as the ribs, hyoid apparatus, transverse and neural processes of vertebrae and scapula. We observed three individuals with ankylosis between the cervical vertebrae and two individuals with morphological changes (cranio-caudally elongated hemal arch and flattened cranial margin of the scapula). The only observed pathology was a case of osteomyelitis in the left dentary, which caused the loss of teeth, deformation of the associated alveoli and the formation of a medial fistula (lingual) for drainage of purulent material. This represents the first record of osteomyelitis in S. fluviatilis.

Association of N-acetylaspartate and cerebrospinal fluid Aβ42 in dementia.

The interplay of amyloid and mitochondrial function is considered crucial in the pathophysiology of Alzheimer's disease (AD). We tested the association of the putative marker of mitochondrial function N-acetylaspartate (NAA) as measured by proton magnetic resonance spectroscopy within the medial temporal lobe and cerebrospinal fluid amyoid-β42 (Aβ42), total Tau and pTau181. 109 patients were recruited in a multicenter study (40 mild AD patients, 14 non-AD dementia patients, 29 mild cognitive impairment (MCI) AD-type patients, 26 MCI of non-AD type patients). NAA correlated with Aβ42 within the AD group. Since the NAA concentration is coupled to neuronal mitochondrial function, the correlation between NAA and Aβ42 may reflect the interaction between disrupted mitochondrial pathways and amyloid production.

Prise en charge des troubles oculomoteurs après effraction iatrogène de l'orbite au cours d'interventions sinusiennes endoscopiques [Management of motility disorders secondary to iatrogenic orbital fracture during endoscopic sinus surgery.]

PURPOSE: Orbital wall fracture may occur during endoscopic sinus surgery, resulting in oculomotor disorders. We report the management of four cases presenting with this surgical complication. METHODS: A non-comparative observational retrospective study was carried out on four patients presenting with diplopia after endoscopic ethmoidal sinus surgery. All patients underwent full ophthalmologic and orthoptic examination as well as orbital imaging. RESULTS: All four patients presented with diplopia secondary to a medial rectus lesion confirmed by orbital imaging. A large horizontal deviation as well as limitation of adduction was present in all cases. Surgical management consisted of conventional recession-resection procedures in three cases and muscle transposition in one patient. A useful field of binocular single vision was restored in two of the four patients. CONCLUSION: Orbital injury may occur during endoscopic sinus surgery and cause diplopia, usually secondary to medial rectus involvement due to the proximity of this muscle to the lamina papyracea of the ethmoid bone. Surgical management is based on orbital imaging, duration of the lesion, evaluation of anterior segment vasculature, results of forced duction testing and intraoperative findings. In most cases, treatment is aimed at the symptoms rather than the cause, and the functional prognosis remains guarded.

Extensor carpi ulnaris (ECU) subsheath: Normal MRI appearance and findings in athletic injuries : 40

Purpose: First, to report ECU subsheath's normal MRI appearance and the findings in athletic injuries. Second, to determine the best MRI sequence for diagnosis. Methods and materials: Sixteen patients (13 males, 3 females, mean age 30.3 years) with ECU subsheath's athletic injuries sustained between January 2003 and June 2009 were retrospectively reviewed. Wrist MRI studies were performed on 1.5-T units and consisted of at least transverse T1 and STIR sequences in pronation, and FS Gd T1 in pronation and supination. Two radiologists assessed the following items, in consensus: injury type (A to C according to Inoue), ECU tendon stability, and associated lesions (ulnar head oedema, extensor retinaculum injury, ECU tendinosis and tenosynovitis). Then, each reader independently rated the sequences' diagnostic value: 0 = questionable, 1 = suggestive, 2 = certain. Follow-up studies were present in 8 patients. ECU subsheath's normal visibility (medial, central and lateral parts) was retrospectively evaluated in 30 consecutive control MRI studies. Results: FS Gd T1 sequences in supination (1.63) and pronation (1.59) were the most valuable for diagnosis, compared to STIR (1.22) and T1 (1). The study group included 9 type A, 1 type B and 6 type C injuries. There were trends towards diminution in pouches' size, signal intensity and enhancement in follow-up studies, along with tendon stabilization within the ulnar groove. In control studies, ECU subsheath's visibility in medial, central and lateral parts were noted in 66.7-80%, 63.3-80% and 30-50% respectively. Conclusion: ECU subsheath's athletic injuries are visible on 1.5-T MRI studies. FS Gd T1 sequences in supination and pronation are the most valuable.

"How I Do It"-Radical Right Colectomy with Side-to-Side Stapled Ileo-Colonic Anastomosis.

BACKGROUND AND OBJECTIVE: Standardization of surgical technique helps to reproduce excellent clinical outcomes, especially in teaching institutions. We aim to describe in detail our established approach for oncological right colectomy. TECHNIQUE: The right colon is mobilized in a five-step latero-inferior approach starting off with (1) the terminal ileum, visualizing the duodenum and the head of pancreas. (2) The ascending colon is dissected from the retroperitoneum, and takedown of the hepatic flexure is completed coming retrograde from the transverse colon (3). (4) Transection of the remaining retroperitoneal attachments completes exposure of the duodenum and mobilization of the right colon. (5) Ileocolic vessels are dissected out and divided close to their origin, and the mesocolon is divided. We then establish intestinal continuity by use of a side-to-side stapled technique. (1) The arms of a linear cutting stapler are inserted via transverse incisions at the anti-mesenteric sides of the terminal ileum and the transverse colon (tenia) and fired. (2) The enterotomy site is closed by removal of the specimen using a second transverse firing of the linear cutting stapler. An important final step is the (3) reinforcement of the anastomotic ends and the crossing of the staple lines; an omental patch and closure of the mesenteric window are optional. CONCLUSION: The suggested standardized five-step lateral-to-medial dissection of the right colon and the three-step side-to-side stapled technique for ileo-colonic anastomosis are easy to learn and to reproduce. Careful adherence to pivotal technical details will help to obtain an optimal oncological outcome and a consistently low leak rate around 2 %.

Natural infection of wild rodents by Schistosoma mansoni parasitological aspects

The evaluation of the role of rodents as natural hosts of Schistosoma mansoni was studied at the Pamparrão Valley, Sumidouro, RJ, with monthly captures and examination of the animals. Twenty-three Nectomys squamipes and 9 Akodom arviculoides with a shistosomal infection rate of 56.5% and 22.2% respectively eliminated a great majority of viable eggs. With a strain isolated from one of the naturally infected N. squamipes, we infected 75% of simpatric Biomphalaria glabrata and 100% of albino Mus musculus mice. The adult worms, isolated from N. squamipes after perfusion were located mainly in the liver (91.5%) and the mesenteric veins (8.5%). The male/female proportion was 2:1. The eggs were distributed on small intestine segments (proximal, medial and distal portions) and the large intestine without any significant differences in egg concentration of these segments. In A. arviculoides, the few eggs eliminated by the stools were viable and there was litlle egg retention on intestinal segments. Considering the ease to complete S. mansoni biological cycle in the Nectomys/Biomphalaria/Nectomys system under laboratory conditions, probably the same is likely to occur in natural conditions. In support to this hypotesis there are also the facts that human mansonic shistosomiasis has a very low prevalence in Sumidouro and endemicity among the rodents has not changed even after repetead treatments of the local patients. Based on our experiments, we conclude that N. squamipes has become a natural host of S. mansoni and possibly may participate in keeping the cycle of schistosomiasis transmission at Pamparrão Valley.

Nectomys squamipes (Rodentia: Cricetidae) as an experimental model for schistosomiasis mansoni

Twenty specimens of Nectomys squamipes born in captivity, were infected with 500 cercariae by the transcutaneous route. Coprologic examinations were carried out from the 5th to 23rd week after infection. On the 7th, 8th, 12th, 16th, and 23rd weeks the animals were sacrificed and perfused. The oogram was performed in segments of the small intestine (proximal, medial and distal portions) and the large intestine. The average pre-patent period was of 42 days. The average number of eggs varied from 350 on 6th week, to 800 on the 13th. From the 14th week on, the average number of eggs eliminated was lower than 50 per gram of feces. The recovery of worms kept steady on the 7th, 8th, and 12th week (16.85%; 15.45% and 11.95%), decreasing to 7.70% on the 16th week and 8.45% on the 23rd week. The proportion of male/female worms was about the same on the first two weeks, but from the 12th week on, the proportion was: 1,4/1 on the 12th week; 2,5/1 on the 16thweek and 1,8/1 on the 23rd weekThese observations suggest that N. squamipes may used as an experimental model for schistosomiasis mansoni, to wich it develops resistance mechanism, useful for immunity studies.