Lower Extremity Trauma: A Multidimensional Reconstructive Approach with Hyperbaric Oxygen Therapy.

Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect's depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects.

Clinical Evaluation of the Efficacy and Tolerability of Rigenase® and Polyhexanide (Fitostimoline® Plus) vs. Hyaluronic Acid and Silver Sulfadiazine (Connettivina® Bio Plus) for the Treatment of Acute Skin Wounds: A Randomized Trial.

OBJECTIVES: Compare the efficacy and tolerability of Connettivina® Bio Plus (Group A) gauze and cream, and Fitostimoline® Plus (Group B) gauze and cream for the treatment of acute superficial skin lesions. DESIGN: Single-center, parallel, randomized trial. A block randomization method was used. SETTING: University of Salerno-AOU San Giovanni di Dio e Ruggi d'Aragona. PARTICIPANTS: Sixty patients were enrolled. All patients fulfilled the study requirements. INTERVENTION: One application of the study drugs every 24 h, and a six-week observation period. MAIN OUTCOME MEASURES: Efficacy and tolerability of the study drugs. RESULTS: In total, 60 patients (Group A, n = 30; Group B, n = 30) were randomized; mean age was 58.5 ± 15.8 years. All patients were included in the outcome analysis. Total wound healing was achieved in 17 patients undergoing treatment with Connettivina® Bio Plus and 28 patients undergoing treatment with Fitostimoline® Plus. The greater effectiveness of the latter was significant (p = 0.00104). In Group B, a significantly greater degree of effectiveness was observed in reducing the fibrin in the wound bed (p = 0.04746). Complications or unexpected events were not observed. CONCLUSIONS: Both Connettivina® Bio Plus and Fitostimoline® Plus are secure and effective for treating acute superficial skin lesions. Fitostimoline® Plus was more effective than Connettivina® Bio Plus in wound healing of acute superficial skin lesions, especially if fibrin had been observed in the wound bed.

Atypical cytological presentation of granular cell tumour: Tumour-associated fibrosis may affect fine-needle aspiration cytology accuracy.

The cytological features of granular cell tumour (GCT) are generally quite typical but, in some cases, the fine needle aspiration cytology (FNAC) diagnosis of GCT may be difficult or impossible because of unusual sites of onset or equivocal cytological features. In this report, two GCTs with atypical FNAC features are described in order to investigate the causes and provide possible diagnostic tips. From a series of nine histologically proven GCTs, two inconclusive FNAC cases were retrieved. Smears were poorly cellular showing isolated naked nuclei, anisonucleosis, granular chromatin and occasional small nucleoli. The background was finely granular in one case. Histological controls of these cases revealed marked fibrosis. Tumour-associated fibrosis in GCT is variable and does not seem to influence clinical behaviour but it influences the harvest and the integrity of granular cells collected by FNAC. When GCT smears are poorly cellular, attention should be paid to the granular background and to the few granular cells, if any, as they might be the only features to suggest a GCT.

Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension.

OBJECTIVE: The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. LOCATION: The University of São Paulo Medical School, Brazil; Public Practice. METHODS: Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15). RESULTS: The cardiac output (5.08 ± 0.91 L/min) and systolic volume (60.1 ± 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). CONCLUSIONS: The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.

Early detection of global and regional left ventricular diastolic dysfunction in systemic lupus erythematosus: the role of the echocardiography.

INTRODUCTION: Bidimensional echocardiography is a non-invasive imaging diagnostic method that effectively assesses global and regional left ventricular diastolic function. Disruption of left ventricular diastolic function in systemic lupus erythematosus (SLE) is almost always clinically silent, suggesting a subclinical diastolic dysfunction. OBJECTIVE: We evaluate in the the present study the different echocardiographic techniques available to assess the diastolic dysfunction in SLE. PATIENTS AND METHODS: Fifty consecutive SLE patients and 50 healthy females, matched by gender and age, were evaluated. Exams were conducted by two independent observers whose results showed concordance. RESULTS: Significant differences in global left ventricular diastolic function between both groups, except for mitral flow propagation velocity (Vp), which showed a reduction in rapid filling in SLE patients, were not observed. Greater involvement of regional diastolic function, in protodiastole, at the level of the mitral ring, especially in the basal area of the interventricular septum, was observed. CONCLUSION: Left ventricular diastolic dysfunction in SLE patients can be identified by tissue Doppler of the mitral ring and by mitral flow propagation velocity.

Detecção precoce da disfunção diastólica global e regional do ventrículo esquerdo no lúpus eritematoso sistêmico: o papel da ecocardiografia / Early detection of global and regional left ventricular diastolic dysfunction in systemic lupus erythematosus: the role of the echocardiography

INTRODUÇÃO: A ecocardiografia bidimensional é um método de diagnóstico por imagem não invasivo que avalia, de modo eficaz, a função diastólica global e regional do ventrículo esquerdo. O comprometimento da função diastólica ventricular esquerda no lúpus eritematoso sistêmico (LES) é quase sempre silencioso, sugerindo um estado subclínico de disfunção diastólica. OBJETIVO: Este estudo tem por finalidade demonstrar as diversas técnicas ecocardiográficas para a aferição da função diastólica no LES. PACIENTES E MÉTODOS: Foram avaliadas consecutivamente 50 pacientes com LES e 50 controles do sexo feminino, pareadas por sexo e idade. Os exames foram realizados por dois observadores independentes cujos resultados tiveram concordância. RESULTADOS: Não houve diferença significativa da função diastólica global do ventrículo esquerdo entre os grupos, exceto pelo método da velocidade de propagação do fluxo mitral (Vp), que evidenciou diminuição da velocidade de enchimento rápido nas pacientes com LES. Foi detectado maior comprometimento da função diastólica regional nas pacientes com LES, na protodiástole, à altura do anel mitral, mais evidente na porção basal do septo interventricular. CONCLUSÃO: No LES, a disfunção diastólica do ventrículo esquerdo pode ser constatada através da avaliação do Doppler tissular na região do anel mitral e pela velocidade de propagação do fluxo mitral.

INTRODUCTION: Bidimensional echocardiography is a non-invasive imaging diagnostic method that effectively assesses global and regional left ventricular diastolic function. Disruption of left ventricular diastolic function in systemic lupus erythematosus (SLE) is almost always clinically silent, suggesting a subclinical diastolic dysfunction. OBJECTIVE: We evaluate in the the present study the different echocardiographic techniques available to assess the diastolic dysfunction in SLE. PATIENTS AND METHODS: Fifty consecutive SLE patients and 50 healthy females, matched by gender and age, were evaluated. Exams were conducted by two independent observers whose results showed concordance. RESULTS: Significant differences in global left ventricular diastolic function between both groups, except for mitral flow propagation velocity (Vp), which showed a reduction in rapid filling in SLE patients, were not observed. Greater involvement of regional diastolic function, in protodiastole, at the level of the mitral ring, especially in the basal area of the interventricular septum, was observed. CONCLUSION: Left ventricular diastolic dysfunction in SLE patients can be identified by tissue Doppler of the mitral ring and by mitral flow propagation velocity.

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements.

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office...

Evaluation of efficacy, reliability, and tolerability of sibutramine in obese patients, with an echocardiographic study.

UNLABELLED: This is a double-blind, placebo-controlled study of the efficacy, safety, and tolerability of sibutramine in the management of obese patients for a 6-month period. METHOD: Sixty-one obese patients (BMI >30, <40 kg/m2), aged 18-65 years were evaluated. In the first phase of the study (30 days), the patients were given a placebo. We monitored compliance with a low-calorie diet (1200 kcal/day) and to the placebo. In the next stage, the double-blind phase (6 months), we compared placebo and sibutramine (10 mg/day). The criteria for evaluating efficacy were weight loss, reduction in body mass index (BMI), and abdominal and hip circumferences. Tolerability was assessed based on reported side effects, variation in arterial blood pressure and heart rate, metabolic profile (fasting glucose, total cholesterol and its fractions, and triglycerides), laboratory tests (renal and hepatic functions), and flow Doppler echocardiogram. RESULTS: We observed a greater weight loss (7.3 kg, 8% vs 2.6 kg, 2.8%) and a reduction in body mass index (7.4% vs 2.1%) in the sibutramine group than in the placebo group. Classifying the patients into 4 subgroups according to weight loss (weight gain, loss <5%, loss of 5% to 9.9%, and loss >10%), we observed a weight loss of >5% in 40% of the patients on sibutramine compared with 12.9% in the placebo group. We also detected weight gain in 45.2% of the placebo group compared to 20% in the sibutramine group. The sibutramine group showed improvement in HDL- cholesterol values (increased by 17%) and triglyceride values (decreased by 12.8%). This group also showed an increase in systolic blood pressure (6.7%, 5 mmHg). There were no changes in echocardiograms comparing the beginning and end of follow-up, and side effects did not lead to discontinuation of treatment. DISCUSSION: Sibutramine proved to be effective for weight loss providing an 8% loss of the initial weight. Compliance to prolonged treatment was good, and side effects did not result in discontinuation of treatment. These data confirmed the good efficacy, tolerability, and safety profiles of sibutramine for treatment of obesity.

Evaluation of efficacy, reliability, and tolerability of sibutramine in obese patients, with an echocardiographic study

This is a double-blind, placebo-controlled study of the efficacy, safety, and tolerability of sibutramine in the management of obese patients for a 6-month period. METHOD: Sixty-one obese patients (BMI >30, <40 kg/m2), aged 18-65 years were evaluated. In the first phase of the study (30 days), the patients were given a placebo. We monitored compliance with a low-calorie diet (1200 kcal/day) and to the placebo. In the next stage, the double-blind phase (6 months), we compared placebo and sibutramine (10 mg/day). The criteria for evaluating efficacy were weight loss, reduction in body mass index (BMI), and abdominal and hip circumferences. Tolerability was assessed based on reported side effects, variation in arterial blood pressure and heart rate, metabolic profile (fasting glucose, total cholesterol and its fractions, and triglycerides), laboratory tests (renal and hepatic functions), and flow Doppler echocardiogram. RESULTS: We observed a greater weight loss (7.3 kg, 8 percent vs 2.6 kg, 2.8 percent) and a reduction in body mass index (7.4 percent vs 2.1 percent) in the sibutramine group than in the placebo group. Classifying the patients into 4 subgroups according to weight loss (weight gain, loss <5 percent, loss of 5 percent to 9.9 percent, and loss >10 percent), we observed a weight loss of >5 percent in 40 percent of the patients on sibutramine compared with 12.9 percent in the placebo group. We also detected weight gain in 45.2 percent of the placebo group compared to 20 percent in the sibutramine group. The sibutramine group showed improvement in HDL- cholesterol values (increased by 17 percent) and triglyceride values (decreased by 12.8 percent). This group also showed an increase in systolic blood pressure (6.7 percent, 5 mmHg). There were no changes in echocardiograms comparing the beginning and end of follow-up, and side effects did not lead to discontinuation of treatment. DISCUSSION: Sibutramine proved to be effective for weight loss providing an 8 percent loss of the initial weight. Compliance to prolonged treatment was good, and side effects did not result in discontinuation of treatment. These data confirmed the good efficacy, tolerability, and safety profiles of sibutramine for treatment of obesity

Contribuiçäo do estudo ecocardiográfico na avaliaçäo das funçöes sistólica e diastólica de mulheres obesas versus grupo controle / Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group

OBJECTIVE: To study by doppler echocardiography the cardiac systolic and diastolic functions of health, uncomplicated obese subjects. METHODS: Fifty-nine obese women with an average body mass index (BMI) of 35 kg/m² were evaluated and compared with 19 subjects with an average BMI of 23 kg/m² (control group). RESULTS: In the obese group, a clear tendency was observed toward higher systolic pressure, increased wall thickness and, consequently, myocardial mass, elevation on the circumference stress of the left ventricular wall, and an indisputable presence of diastolic abnormalities. Filling abnormalities were observed with impaired relaxation, with prolonged isovolumic relaxation time (IVRT) and augmented atrium contribution representing early indexes of cardiac dysfunction when systolic performance is still normal. CONCLUSION: Obesity is generally a chronic condition, and doppler echocardiography can be used as a noninvasive instrument for early evaluation of left ventricular diastolic indexes

Aspectos ecodopplercardiograficos em indivíduos muito idosos / Dopler echocardiographic aspects in the very elderly

Estudaram-se os ecodopplercardiogramas de 122 indivíduos com 80 a 101 (média: 91,5) anos, 41 do sexo masculino e 81 do feminino, matriculados no ambulatório geriátrico, onde este exame é realizado de rotina. Os idosos foram divididos em dois grupos etários: A) 91 indivíduos com 80 a 89 anos; B) 31 indivíduos com 90 a 101 anos. Os registros foram tecnicamente inadequados para análise em 20 (16,4 por cento) idosos, 12 (13,2 por cento) do grupo A e oito (25,8 por cento) do grupo B. Nos demais 102 indivíduos verificou-se que o ecodopplercardiograma foi normal em nove (11,4 por cento) do grupo A e três (13,0 por cento) do grupo B. As principais alteraçöes observadas foram hipertrofia ventricular esquerda (38,2 por cento) insuficiência mitral (33,3 por cento), reduçäo da complacência de ventrículo esquerdo (32,4 por cento), aumento átrio esquerdo (25,5 por cento) e insuficiência aórtica (24,5 por cento), havendo diferença significativa entre os grupos A e B apenas em relaçäo a insuficiência aórtica, que predominou no grupo A. Em relaçäo ao sexo, observou-se que insuficiência mitral, aumento de átrio esquerdo e ectasia aórtica significativamente mais frequente nos homens. Alteraçöes isoladas foram verificadas em 18 (17,6 por cento) e associadas em 72 (70,6 por cento) idosos. Os resultados obtidos permitiram concluir que em indivíduos muito idosos as alteraçöes cardíacas säo frequentes, inclusive associada, porém se encontram indivíduos com o coraçäo normal sob o ponto de vista ecodopplercardiografico

Paracoccidioidomicose na infância: diagnóstico por imagens; relato de um caso / Paracoccidioidomycosis in childhood

Os autores relatam o caso de uma criança do sexo feminino, de oito anos de idade, portadora de paracoccidioidomicose profunda, com febre intermitente, hepatomegalia, linfadenopatia abdominal, comprometimento do esqueleto com lesöes ósseas do tipo osteolítico, acompanhado de aumento das partes moles e cardiomegalia com derrame pericárdio, sem acometimento pulmonar

Calcificaçäo valvar cardíaca em idosos / Cardiac valvular calcification in the elderly

O estudo ecodopplercardiográfico de 1.107 pacientes ambulatoriais, com idade igual ou superior a 60 anos, evidenciou que 130 (11,8 por cento) eram portadores de calcificaçao valvar cardíaca (CVC), sendo 86 de calcificaçao mitral (CM), 22 de calcificaçao aórtica (Cao) e 22 de calcificaçao mitro-aórtica (CMAo). A análise dos dados clínicos, eletrocardiográficos, ecodopplercardiográficos e laboratoriais permitiu evidenciar: 1) a CM predominou no sexo feminino (X2 = 7,97) enquanto a Cao predominou no masculino (X2 = 4,47); 2) a incidência de CVC aumentou com o progredir da idade; 3) afecçoes cardiocirculatórias que elevam a pressao intraventricular esquerda, principalmente a hipertensao arterial, foram as mais observadas nos portadores de CVC; 4) nao se evidenciaram antecedentes de enfermidades que pudessem ter lesado previamente as valvas; 5) estenose e/ou insuficiência nas respectivas valvas foram encontradas em 33,7 por cento dos casos de CM, 59,1 por cento de CAo e 54,5 por cento de CMAo; 6) induficiência cardíaca foi observada em 25,6 por cento dos casos de CM, 13,6 por cento de Cao e 22,7 por cento de CMAo; 7) alteraçoes eletrocardiográficas foram mais freqüentes; 8) nao se observaram alteraçoes do colesterol total, triglicérides e do cálcio séricos. A vista do exposto, recomenda-se que os portadores de CVC sejam acompanhados periodicamente para que as complicaçoes sejam detectadas e tratadas precocemente.

Contribuiçäo dos métodos da imagem no estudo da doença de Chagas / Contribution of the imagenological methods in the study of Chagas disease

A doença de Chagas constitui ainda sério problema de saúde pública no continente americano, apesar do possível controle epidemiológico preventivo. Foram examinados 300 pacientes (geralmente por um dos métodos) através de exames radiológicos convencionais simples e contrastados, de US, de TC, de radioisótopos e da ecocolordopplercardiografia nas fases aguda, indeterminada e crônica das manifestaçöes neurológicas, digestivas e cardíacas da doença, visando avaliar o impacto causado pelos novos métodos imagenológicos no estudo dos portadores da doença de Chagas. Constatou-se que, apesar do grande avanço no estudo funcional das alteraçöes principalmente digestivas e cardíacas, causado pelas técnicas imagenológicas recentes, o exame contrastado do trato digestivo ainda ocupa lugar importante no estudo desses pacientes

Manifestaçöes cardíacas do hipertireoidismo no idoso / Cardiac manifestations of hyperthyroidism in the elderly

Analisar as manifestaçöes cardiocirculatórias do hipertireoidismo em idosos. Vinte e quatro portadores de hipertireoidismo com idades variando de 60 a 87 (média 73,5) anos, 18 do sexo feminino. A análise cardiocirculatória foi realizada através dos exames clínico, eletrocardiográfico, radiológico, fonomecanocardiográfico e ecocardiográfico. Manifestaçöes cardiocirculatórias foram observadas em 17 (70,9%) idosos, nove (37,5%) com insuficiência cardíaca. Alteraçöes eletrocardiográficas foram evidenciadas em 20 (83,8%) casos, predominando as taquiarritmias (62,5%) fibrilaçäo atrial crônica em oito (33,3%) e taquicardia sinusal em cinco (20,8%). Analisando-se separadamente os pacientes com e sem doença cardiocirculatória associada, näo se observaram diferenças estatisticamente significativas nos vários parâmetros eletrocardiográficos estudados. A freqüêmcia de cardiomegalia foi estatisticamente mais elevada nos hipertireoideos, tanto portadores (64,7%) como näo portadores (57,1%) de afecçöes cardiocirculatórias associadas, em relaçäo aos idosos normais (23,9%). O desempenho ventricular esquerdo avaliado em 14 pacientes, através do quociente sistólico mostrou-se normal ou elevado em 12 (85,7%). O percentual de encurtamento da fibra (delta D%) foi maior que 30% em todos os casos em que foi determinado. Nenhum paciente apresentou ao ecocardiograma alteraçöes sugestivas de cardiomiopatia hipertrófica simétrica ou assimétrica e de prolapso mitra. O hipertireoidismo no idoso determina ...

Diagnóstico pré-natal das cardiopatias congênitas e arritmias pela ecodopplercardiografia / Prenatal diagnosis of congenital heart diseases and cardiac dysrrhythmias by echocardiography

Detectar precocemente cardiopatias congênitas e arritmias pela EcoDopplercardiografia em gestantes pertencentes ao grupo de risco para tais alteraçöes de acordo com as indicaçöes clássicas. Ecocardiografia bidimensional associada ao Modo M e Doppler foi realizada em 200 gestantes pelas seguintes indicaçöes: diabete materna, arritmia fetal, filho anterior com cardiopatia, retardo de crescimento intra-uterino, hidropsia fetal näo imune, rubéola materna, isoimunizaçäo, malformaçöes fetais ao ultra-som, polihidrámnio, gemelidade, oligoâmnio, ingestäo materna de drogas, lupus eritematoso sistêmico e outros. Anormalidades estruturais isoladas foram encontradas em 6 casos e associadas com bradiarritmia em 5 casos (total 5,5%). Arritmias fetais sem malformaçäo cardíaca ocorreram em 30 casos (15%) sendo a extrrasistolia atrial a mais freqüente. Os achados deste estudo inicial indicam que a anatomia e funçäo cardíaca fetal podem ser avaliados com precisäo. Baseados nisto, temos divulgado o método enfatizando suas indicaçöes, com a finalidade de proporcionar cada vez mais assistência adequada ao feto e ao recém-nascido portadores de cardiopatia congênita ou arritmia

Purpose - To detect in prenatal life fetal arrhythmia and congenital heart disease. We performed fetal echocardiography following classical indications according to the literature. Patients and Methods - Two-dimensional echocardiography associated with M-mode and Doppler was performed in 200 patients according to the indications: maternal diabetes, fetal arrhythmia, maternal congenital heart disease, previous fetus with cardiac defect, intrauterine growth retardation, nonimmune fetal hydrops, rubeola, isoimunization, fetal malformation by ultrasound, polyhidramnio, gemelarity, olygohydramnio, maternal ingestion of drugs, lupus and others. Results - Structural abnormalities of the heart were found in 6 cases and associated with bradiarrhythmia in 5 cases (total of 5,5%). Fetal arrhythmias without cardiac malformation were found in 35 cases (17,5%) and premature atrial contractions were the most frequent. Conclusion - The findings in this study indicate that it is possible the accurate definition of the cardiac anatomy and function. We have enphazised the method trying to spread it, objecting to improve assistance to the fetus and newborn with arrhythmias anal or congenital heart disease

Tratamento cirúrgico de fibroma de ventrículo direito em lactentes: relato de dois casos / Surgical treatment of right ventricular fibroma in infants: report of 2 cases

Fibroma de ventrículo direito foi diagnosticado em duas crianças com idades de três a quatro meses. Os sintomas e o exame clínico eram sugestivos de estenose pulmonar. O diagnóstico foi feito com o auxílio do ecocardiograma e também da tomografia computadorizada e da angiocardiografia em um caso. Os paciente sforam submetidos a tratamento cirúrgico, obtendo-se sucesso na ressecçäo do tumor

Two patients under 8 months of age, with right ventriculr fibroma, presented with clinical manifestations of pulmonary stenosis. The diagnosis was stablished in one by echocardiography and in the other by echocardiography. CT scan and angiocardiographic study. The patients were operated and the tumors were sucessfully ressected.