Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases

OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5±3.1 (27-38) weeks and maternal age was 28.2±8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22±0.34 (1.66-2.81) m/s, diastolic velocity 0.79±0.28 (0.45-1.5) m/s, and pulsatility index 1.33±0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13±0.33) than in group B (0.68±0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

A elite política parlamentar portuguesa: caracterização, cristalização e circulação (2005-2011)

Dissertação de Mestrado em Ciência Política

Design of a bifurcated stent graft, with its accompanying delivery system.

Abdominal Aortic Aneurysms (AAA) haemorhaging is a life-threatening disease. An aneurysm is a permanent swelling of an artery due to a weakness in its wall. Current surgical repair involves opening the chest or abdomen, gaining temporary vascular control of the aorta and suturing a prosthetic graft to the healthy aorta within the aneurysm itself The outcome of this surgical approach is not perfect, and the quality of life after this repair is impaired by postoperative pain, sexual dysfunction, and a lengthy hospital stay resulting in high health costs. All these negative effects are related to the large incision and extensive tissue dissection. Endovascular grafting is an alternative to the standard surgical method. This treatment is a less invasive method of treating aortic aneurysms. It involves a surgical exposure of the common femoral arteries where the stent graft can be inserted through by an over-the-wire technique. All manipulations are controlled from a remote place by the use of a catheter and this technique avoids the need to directly expose the diseased artery through a large incision or an extensive dissection. The proposed design method outlined in this project is to develop the endovascular approach. The main aim is to design an unitary bifurcated stent graft (1 e- bifurcated graft as a single component) to treat these Abdominal Aortic Aneurysms. This includes the delivery system and deployment mechanism necessary to first accurately position the stent graft across the aneurysm sac and also across the iliac bifurcation, and secondly fix the stent graft in position by using expandable metal stents. Thus, excluding the aneurysm from the circulation and therefore preventing rupture. Miniaturisation is a critical aspect of this design, as the smaller the crimped stent graft the easier to guide through the vascular system to the desired location. Biocompatibility is an important aspect. The preferred materials for this prosthesis are to use Shape Memory Alloys for the stent and a multifilament fabric for the graft. A taper design is applied for the geometry as this gives a favourable flow characteristic and reduced wave reflections. Adequate testing of the stent graft to prove its durability and the ease of the method of deployment is a prerequisite. A bench test facility has being designed and build to replicate the cardiovascular system and the disease in question aortic aneurysms at the iliac bifurcation. The testing here shows the feasibility of the proposed delivery system and the durability of the stent graft across the aneurysm sac. Finally, these endovascular treatments offer the economic advantage of short hospital stays or even treatment as an outpatient, as well as elimination of the need for postoperative intensive care The risk of developing an aneurysm increases with age, that is one of the mam reasons to look for less invasive ways of treating aneurysms. Consequently, there is enormous pressure to develop and use these devices rapidly.

Development of Anatomophysiologic Knowledge Regarding the Cardiovascular System: From Egyptians to Harvey

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation.

Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

Background:Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure.Objective:To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy.Methods:Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy.Results:We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n=9), 6 patients (66.7%) were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B.Conclusion:Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.

Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow

AbstractBackground:The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF).Methods:In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient.Results:The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis.Conclusion:Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.

¿La edad de la política? Balanche Historiográfico de los estudios sobre comunicación e información política en la sociedad ibérica moderna

Los estudios sobre política y su impacto y circulación entre la sociedad moderna, han solido limitar su expansión a un número reducido de personas del entorno más próximo a los grandes actores cortesanos frente a la tradicional “indiferencia” del común. Sin embargo, gracias a la renovación de la historiografía de lo político y a su interés por áreas culturales y sociales ajenas a su tradicional consideración, en las últimas décadas se ha descubierto un interesante terreno de experiencias políticas que nos puede servir como atalaya para conocer la difusión de la información sobre los hechos políticos también entre “gente corriente”. A nuestro juicio, es un momento adecuado para evaluar el desarrollo de un fenómeno historiográfico carente de cierta sistematicidad, razón por la que planteamos este balance crítico y analítico sobre la sociedad ibérica del Antiguo Régimen.

Culicídeos associados a entrenós de bambu e bromélias, com ênfase em Aedes (Stegomyia) albopictus (Diptera, Culicidae) na Mata Atlântica, Paraná, Brasil

Aedes (Stegomyia) albopictus (Skuse, 1894) larvae were recorded for the first time in the internodes of bamboo cuts found in the Atlantic Forest in the State of Paraná, Brazil. The bamboo, Bambusa sp., was introduced in the area of Imbucuí-Mirim town, across the municipal district of Paranaguá and towards the interior of the Atlantic Forest. A total of 251 larvae of Aedes albopictus (37.9%), Culex (Microculex) spp. (13.9%), Limatus durhami Theobald, 1901 (39.8%), Toxorhynchites sp. (0.4%) and Wyeomyia spp. (8.0%) were collected from bamboo internodes filled with rain and from the terrestrial Bromeliaceae and epiphytas found near the bamboo bushes. Aedes albopictus was found in bamboo internodes containing 30 to 254 ml of rain, sometimes coexisting with Li. durhami. Borders of forest ecosystems should be characterized as risk areas for arbovirosis transmission, since they sustain the circulation of vertebrates and arthropodal hematophagus, not only in the wild but also in the anthropic areas.

Modifications de la coagulation sanguine dans la fièvre jaune

L'étude des modifications de la coagulation sanguine à l'aide de la technique BRAZIL-VELLARD, réalisée chez 25 malades atteints de formes diverses, mortelles, graves, et bénignes, entre le lléme et le XIIIéme jour de maladie, et chez 12 convalescents, a permis d'arriver aux conclusions suivantes: 1º. Les variations du pouvoir coagulant du serum sont très irrégulières et peu différentes des celles observées chez de sujets normaux. 2º. La coagulabilité du plasma, dès le IIème jour de la maladie, présente une diminution marquée, constante chez tous les malades, atteignant son chiffre le plus bas entre le VIIème et le IXème jour et revenant progressivement á la normale pendant la convalescence. 3º. Cette diminution de la coagulabilité est due principalement á l'apparition de grandes quantités d'antithrombines dans la circulation; la diminution du fibrinogène observée dans quelques cas, est toujours peu accusée. 4º. La diminution de la coagulabilité du plasma, qui n'a jusqu'ici été observée avec cette intensité que dans la fièvre jaune, peut être d'un certain secours pour le diagnostic précoce de cette affection; elle n'a jamais été vérifiée chez des malades atteints d'autres affections fébriles. 5º. Au point de vue du pronostic, la diminution précoce et très accentuée de la coagulabilité est un symptôme grave, indiquant une lésion profonde de la cellule hépatique. 6º. Dans la fièvre jaune expérimentale du Macacus rhesus, les altérations de la coagulation sanguine sont de même nature, mais paraissent plus tardives et moins accusées que chez l'homme.

Biologia do saguirú (Characidae, Curimatinae)

In Brazil all the fishes belonging to the sub-family Curimatinae are called « saguirú ». The present work gives a biological study of the Curimatus elegans Steind., a small fish without any economical importance, which is to be found along the whole brazilian coast, down till Paraguay. The specimens utilized for the present study come from Fortaleza (Ceará, north-eastern Brazil). The C. elegans is « ilyophagus », that means, it feeds itself exclusively with those organic materials to be found in mud, specially with microscopical algae. The intestines are very extent, some of them measuring about 9 to 11 times body's length. Studies have been made about growth and age of the C. elegans; the biggest sizes found were of 153 mm. for females and 88 mm. for males. The C. elegans shows developed sexual glands during a long period (April to September). The movements of the spermatozoa, in contact with water is of 40 to 50 seconds of intense movements, ceasing after 70 to 100 seconds. In contact with 0.5% NaCl-solution spermatozoa show a big increase in movements-time, that can last till about 25 minutes. The eggs' diameter measures 0.70 to 0.73 mm., mature and hydrated it attains 0.93 to 1,00 mm. There is a certain correlation between the size of the body and the quantity of eggs. Big specimens can produce a total of 200.000 eggs. The average quantity contained in 1 gr. and 1 cc. is 6018 and 6229 eggs, respectively. Maturity and spawning in laboratory has been obtained due to injections of suspension of fish-hypophysis. Three or four hours after the injection, fishes show more movement and evident signs of excitation, proceeding spawning after 5 to 6 hours. Males, persecuting females, describe successive circles (merry-go-round) - carroussel), swimming side by side with females up to water's surface, where sexual products are start beating dry, for there is no blood yet. Circulation-scheme is to be found on fig. 4 and 5. The swim-bladder and the stomach are but delineated; the intestine is formed by a cylindric tube, all closed. At the place, where later on there will open the mouth, we find a group of ciliary hairs that produce a liquid current, very evident by the semi-circle formed by attached solid particles. After 36 hours, opening of the mouth and formation of the gill slits begin. At the age of 90 hours (4 mm.) the larvas swim well and start to feed themselves; the digestive tube is now all open and the swimbladder works already. During the first days of life, larvas have an adhesive organ situated at their frontal region (fig. 7) in form of a crescent, by means of which they hang to surrounding vegetation (fig. 6). When the larva begins to swim and to feed itself and its yolk are having been absorbed. the adhesive organ retracts and disappears. While larvas and alevins feed themselves with plancton, they have small eye-teeth, which disappear,. when fishes become « ilyophagus ». There exist too, during their life as larvas, pharyngeal-teeth. The lateral line appears in the larva after 16 to 18 days; more or less at the same time all fins are completely developed. Shortly after, first scales appear (20 to 23 days). Evolution of intestines twisting followed (fig. 9). Larvas show at different parts of their bodies small of organs excretory functions, that are constituted by bottons in serial disposition, every one with an excretory canal that opens towards the outside. These formations disappear suddenly when larvas attain their phase of alevin. The existence of a great number of said formations at the caudal fin (fig. 12) is of great interest. In our experiences of breeding we have employed several thousands of C. elegans larvas in different environs and we made conditions of surrounding change (illumination), depth of water, temperature, presence of sand at bottom of aquariums and without sand, food). In this way we could compare the results obtained, estimate the action of each factor for the realisation of a good bring-up of larvas.

Lesões microscopicas do baço na purpura trombocitopenica idiopatica

Histopathological changes strikingly similar were found in the spleen of four cases (young female subjects) of idiopathic thrombocytopenic purpura hemorrhagica in which splenectomy was performed. The chief changes reported are enlargement of the marginal zone of the malpighian corpuscles, proliferation and mobilization of the reticulo-endothelial cells, myeloid metaplasia, local (tissue) eosinophilia, and stoppage of the circulation or stasis of platelets from which results a filling of the spelenic sinuses by such elements. The latter phenomenon will possibly present some bearing with thrombocytopenia which is such a characteristic feature in this disease and will perhaps account for the rapid increase in blood platelets which usually follows splenectomy and or the finding of increased megakaryocytes in the bone marrow.

The life history of Hepatozoon leptodactyli (Lesage, 1908) Pessoa, 1970: a parasite of the common laboratory animal: the frog of the genus Leptodactylus

The main object of the present paper is to furnish a brief account to the knowledgement of Protozoa parasitic in common Brazilian frog of the genus Leptodactylus for general students in Zoology and for investigators that use this frog as a laboratory animal. Hepatozoon leptodactyli (Haemogregarina leptodactyli) was found in two species of frogs - Leptodactylus ocellatus and L. pentadactylus - in which develop schizogony whereas sporogony occurs in the leech Haementeria lutzi as was obtainded in experimental conditions. Intracellular forms have been found in peripheral circulation, chiefly in erythrocytes, but we have found them in leukocytes too. Tissue stages were found in frog, liver, lungs, spleen, gut, brain and heart. The occurence of hemogregarine in the Central Nervous System was recorded by Costa & al,(13) and Ball (2). Some cytochemical methods were employed in attempt to differentiate gametocytes from trophozoites in the peripheral blood and to characterize the cystic membrane as well. The speorogonic cycle was developed in only one specie of leech. A brief description of the parasite is given.