Association of deep venous thrombosis with neoplasms in different age groups.

AIM: The objective of the current study was to evaluate if age is related to the prevalence of neoplasms in patients presenting with deep venous thrombosis. METHODS: The existence of neoplasms was investigated in 221 female and 194 male patients suffering from deep venous thrombosis. Their ages ranged from 11 to 92 years old with a mean of 55.2 years. Thoracic radiography, endoscopy, abdominal ultrasonography, computed tomography and magnetic resonance were requested in cases of clinically suspected neoplasms. The inclusion criterion was the presence of deep venous thrombosis and exclusion criterion was that the existence of neoplasms was not investigated. The patients were classified in age groups at 10-year intervals starting at the age of 40 years old. For statistical analysis the one sample t-test and Fisher exact test were utilized with an alpha-error of 5% considered acceptable. RESULTS: Neoplasms were detected in 3.4% of under 40-year-old patients, 5.6% between 40 and 50 years, 16.6% between 50 and 60 years, 26.8% between 60 and 70 years, 19.3% between 70 and 80 years and 10.8% in over 80-year-old. The association between neoplasms and age is significant for over 50-year-old when compared with those under 40-year-old (Fisher exact test P value <0.005) and there is a difference in percentages between the age groups (one sample t test P value=0.01). CONCLUSIONS: In conclusion the prevalence of neoplasms is associated to age with the highest rate in the 60- to 70-year age group.

Effect of whole bone marrow cell infusion in the progression of experimental chronic renal failure.

INTRODUCTION: The therapeutic potential of adult stem cells for the treatment of chronic diseases is becoming increasingly evident over the last few years. In the present study, we sought to assess whether the infusion of bone marrow-derived mononuclear cells (MoSCs) and mesenchymal cells (MSCs) could reduce/stabilize the rate of progression of chronic renal failure (CRF) in rats. METHODS: We used the 5/6 renal mass reduction model to induce chronic renal failure in male Wistar rats. Renal function was assessed by measurements of serum creatinine (sCr), creatinine clearance (Clcr), and 24-hour proteinuria at baseline as well as 60 and 120 days after surgery. MoSCs and MSCs obtained from bone marrow aspirates were separated by the Ficoll-Hypaque method. After a 12- to 14-day culture, 1.5 x 10(6) MSCs and the same number of MoSCs were injected into the renal parenchyma of the remanant kidney of rats with CRF on the day of surgery. RESULTS: Among the control group, at day 120, the results were sCr = 1.31 +/- 0.5 mg/dL, Clcr = 0.64 +/- 0.35 mL/min, and proteinuria = 140.0 +/- 57.7 mg/24 h. Rats treated with MoSCs at day 120 had sCr = 0.81 +/- 0.20 mg/dL, Clcr = 1.05 +/- 0.26 mL/min, and proteinuria = 61 +/- 46.5 mg/24 h, while rats injected with MSCs had sCr = 0.95 +/- 0.1 mg/dL, Clcr = 0.68 +/- 0.24 mL/min, and proteinuria = 119.2 +/- 50.0 mg/24 h. Analysis of the progression to CRF showed that the treatment significantly reduced the rate of decline in Clcr after treatment with MoSc: control: -0.0049 +/- 0.0024 mL/min/d versus MSC: - 0.0013 +/- 0.0017 mL/min/d versus MoSC: +0.0002 +/- 0.0016 mL/min/d (P = .017). Proteinuria tended to be lower among the treated groups. Histological scores of chronic damage were not different, but distinct patterns of chronic lesions were observed among treated rats. CONCLUSION: Our results showed that progression of CRF in rats could be slowed/stabilized by intrarenal parenchymal injection of MoSCs. A trend toward reduction in the progression rate of CRF was also observed with injection of MSCs.

Lymph drainage in patients with joint immobility due to chronic ulcerated lesions.

The fibrous process of chronic ulcerated lesions of lower limbs can impair the mobility of the affected limb. The aim of this work was to assess the benefits of lymph drainage in patients who suffer from this disease. Twenty female and five male patients with ages ranging from 53 to 69 years (mean age 60.6 years) were evaluated. All had a history of at least 10 years of varicose veins and/or ulcerated lesions of the lower limbs with initial dermatofibrosis, with the positive Godet sign during the physical examination of the limb. Patients with intermittent claudication, diabetes and trauma were excluded from the study, as well as patients with chronic dermatofibrosis, and in whom positive Godet sign was not seen. Patients with immobility or very limited movement of the ankle and with some limitation in the toe joints were selected. The patients were randomly divided into group A comprising 15 individuals, and group B 10. All the individual treatments were established before the start of the evaluation period. Lymph drainage was performed on the patients of group A four or five times per week. Group B was subjected to a type of massage for the same period and at the same frequency. The mobility of the ankle joints was evaluated using goniometry before the start and after 30 days of treatment. In all the patients who underwent lymph drainage, an improvement of the joint mobility was seen, whereas in the control, group B, there was no obvious change. In conclusion, lymph drainage gave an improvement in the mobility of the ankle joint after impairment due to initial dermatofibrosis in patients with chronic ulcerated lesions.

Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation

Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations.

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation.

Quality of life and peripheral lymphedema.

Evaluation of the health-related quality of life (QOL) is becoming commonplace, seeking to provide information about the everyday well-being of a patient. This work examined the QOL of 23 consecutive patients with lymphedema of the upper or lower extremities. Five were men and the other eighteen were women. Their ages ranged from 19 to 74 years (mean 48.3). After clinical examination, and with informed consent of each patient, they were assessed by a psychologist and submitted to a QOL test (SF-36). For controls, twenty-three women and five men with age range of 28 to 66 years (mean 47) were similarly evaluated. The results showed the lymphedema group had a statistically significantly reduced QOL in both physical and mental health as well as social interaction.

Speed of particles ejected from animal skin by CO2 laser pulses, measured by laser Doppler velocimetry.

During ablation of tissue with laser pulses rapid sublimation of matter occurs and high pressures are exerted within the tissue, resulting in steam. smoke and particles being expelled. In this paper we report the speed of particles ejected from animal tissue exposed to CO2 laser pulses measured directly by laser Doppler velocimetry (LDV). Speeds recorded just above animal skin were in the range of 9 to 18 m s(-1) for laser pulses of 128 to 384 J cm(-2) respectively. Aerodynamic turbulence slowed the particles down to a critical speed Vc of 4 m s(-1) within a few millimetres above the laser ablation site. Once the particles reach this minimum speed, if no collisions occur, they will only decelerate by gravitational action and the residual kinetic energy will send the particles up to about 0.87 m from the skin surface. Since ejected particles may carry viable cells, acting as disease vectors during laser surgery, our results suggest that the LDV technique should be used to measure the speed of particles ejected from healthy or pathological human tissues, helping to establish safe conditions during laser surgery.

Prevalence of antithrombin deficiency in patients with chronic leg ulcer.

Antithrombin is one of the main endogenous anticoagulants and its deficiency is associated with deep venous thrombosis. The aim of the present study was to evaluate the prevalence of antithrombin deficiency in patients with chronic lower extremity ulcers. Forty-eight patients with chronic lower limb ulcers for longer than 10 years, evaluated during 1997, were studied: 40 were female (83.3%) and eight were male (16.6%), with ages ranging from 43 to 73 years (mean, 55.2 years). Antithrombin was dosed by the coagulometric method, with evaluation of the functional activity. Measurement was repeated in those cases where deficiency was found to be present. The highest prevalence rate for antithrombin deficiency in the general population was one in every 2000 cases. Data analysis was performed by utilizing the odds ratio with a confidence interval of 95% and P < 0.05. Deficiency in antithrombin levels was recorded in two (4.1%) of the patients with chronic ulcer. These results indicate a higher prevalence rate of antithrombin deficiency in those patients with chronic leg ulcers, suggesting that an association may be present. Further studies with a larger number of patients are required to confirm this hypothesis.

Superficial thrombophlebitis and anticardiolipin antibodies--report of association.

The aim of this study was to determine a possible association between recidivist superficial thrombophlebitis and anticardiolipin antibodies. Forty-five patients with two or more episodes of superficial thrombophlebitis in lower limbs (33 women and 12 men with ages ranging from 17 to 60 years, average: 39.8) were studied. The control group was formed by 100 voluntary donors from the blood bank (83 men and 17 women, age range: 21 to 59 years, average: 35.4). Anticardiolipin antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA). For semiquantitative detection in human sera with use of QUANTA Lite ACA IgG/IgM--INOVA Diagnostic, Inc., and positive values were considered as 15 GPL units/mL and 12.5 MPL units/mL for immunoglobulin G (IgG) and IgM, respectively, as recommended by the test. The Odds Ratio method was chosen for statistical analysis with a confidence interval (CI) of 95%. In 15 patients (33.3%) anticardiolipin antibody positivity was detected, whereas in 12 patients (26.7%) it occurred as immunoglobulin M (IgM) anticardiolipin and in 3 (6.7%) as immunoglobulin G anticardiolipin. In the control group, positivity was found in 7 patients (7%) for those antibodies. Furthermore, the Odds Ratio = 6.64 with CI = 95% and values ranging from 2.48 to 17.82 (p < 0.05) were significant, as well as for IgM/IgG anticardiolipin proportion with Odds Ratio = 5.09, C = 95% and values varying from 1.33 to 19.54 (p < 0.05). The authors conclude that there is a correlation between the presence of anticardiolipin antibodies and recurrent superficial thrombophlebitis.

Mitral valve repair with a malleable bovine pericardium ring.

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and Doppler echocardiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4+/-17.2) years, were studied over a 16-month period, with 100% follow-up. In 23 (72%) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2%) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On Doppler echocardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions). Of four (12%) of the remaining patients, 6% had moderate and 6% had accented insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%), II (32%), and III (3%), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.

Dynamic cardiomyoplasty: long-term clinical results in patients with dilated cardiomyopathy.

BACKGROUND: Dynamic cardiomyoplasty has been considered to be an effective method of surgical treatment of patients with end-stage heart failure, and is an alternative to heart transplantation. METHODS: We critically evaluated the long-term course of 52 patients with dilated cardiomyopathy who underwent dynamic cardiomyoplasty and were followed-up for up to 110 months. RESULTS: Dilated cardiomyopathy was due to undetermined cause in 42 patients (80.8%), Chagas disease in 8 (15.4%), viral infection in 1 (1.9%), and peripartum cardiomyopathy in 1 (1.9%). In the nonchagasic group the survival rates were 79.5% +/- 6.1%, 67.8% +/- 7.1%, 53.7% +/- 8.3%, 49.9% +/- 8.3%, 14.9% +/- 12.2%, and 14.9% +/- 12.2%, respectively, at 12, 24, 48, 60, 80 and 110 months of follow-up. In the chagasic patients the survival rates were 37.5% +/- 17.1%, 12.5% +/- 11.7%, 12.5% +/- 11.7% and 0%, respectively, at 12, 24, 48, and 60 months of follow-up, making chagasic cardiomyopathy a possible contraindication for dynamic cardiomyoplasty. CONCLUSIONS: There was no correlation between the clinical improvement and hemodynamic data. Ventricular fibrillation was a frequent cause of immediate and late death, suggesting the need for prophylactic use of antiarrhythmic drugs or implantable cardioverter/ defibrillators.

Prevalence of anticardiolipin antibodies in peripheral arterial thrombosis.

The aim of this study was to assess prospectively the prevalence of anticardiolipin antibodies in patients with peripheral arterial thrombosis. Fifty-nine patients with arterial thrombosis (38 men, 21 women), ages ranging from 24 to 80 years, mean age, 45.5 years, were studied. The control group included 100 volunteer blood donors. After confirmation of the thrombotic event, anticardiolipin antibodies were dosed by the immunoassay enzyme method and by dilution. In Group I these antibodies were present in 62.7% of the patients, of which 33.9% were borderline and 28.8% were positive. In the control group 6% of the patients were borderline and 1% was positive. The statistical analysis showed that the prevalence found was statistically significant (p < 0.001), even when the borderline titers were not considered positive. Patients with peripheral arterial thrombosis have a high prevalence of anticardiolipin antibodies.

Preparation and characterization of collagen-elastin matrices from blood vessels intended as small diameter vascular grafts.

This study describes the selective removal of cell and cell residues from small and large diameter blood vessels for the preparation of tubular collagen:elastin matrices intended for small diameter vascular prosthesis. The results showed that total or partially devitalized collagen:elastin matrices may be conveniently prepared without denaturation of the collagen:elastin matrix with a high degree of preservation of the proteins. The efficiency of cell removal and the extent collagen and elastic fiber preservation were dependent on the segment and the type of blood vessel under study, with arteries characterized by a higher susceptibility of cell removal and better preservation of the collagen-elastin matrix.

Reconstruction of the pulmonary valve and outflow tract with bicuspid prosthesis in tetralogy of Fallot.

BACKGROUND: Right ventricular outflow tract and pulmonary valve implant in patients with tetralogy of Fallot may be required to avoid late postoperative right ventricular impairment. The use of porcine bicuspid prosthesis might be a technical alternative, although comprehensive studies on the long-term use of these prostheses are not available. METHODS: Sixty-three patients (aged 5 months to 34 years; mean, 6 years) with tetralogy of Fallot and pulmonary hypoplasia underwent surgical repair and enlargement of the right ventricular outflow using preserved porcine pulmonary bicuspid prostheses. Fifty-two patients (82.5%) were followed and underwent clinical evaluation and serial Doppler echocardiography. The first 15 patients (29.4%), with ages ranging from 5 to 16 years (mean, 8.2 years) and postoperative follow-up of 48 to 87 months (mean, 65.1 months) underwent hemodynamic and cineangiographic evaluations. RESULTS: There were 11 deaths (17.4%) in the early postoperative period. Of the 52 surviving patients (82.5%), 51 (80.9%) were followed for 1 to 87 months (mean, 42.0 months). Four patients (7.6%) had additional treatment. Of the 15 patients (29.1%) undergoing hemodynamic evaluation, 9 (60%), had mild valvular pulmonary insufficiency and 6 (40%) had moderate insufficiency. Only the right ventricle-to-pulmonary artery pressure gradients and the right ventricular ejection fraction showed statistically significant differences between groups. Right ventricular dimension, although increased in all patients, did not show statistically significant differences. CONCLUSIONS: Right ventricular outflow tract and pulmonary valve repair in patients with tetralogy of Fallot using a bicuspid porcine pulmonary prosthesis is a simple, reliable procedure with good results in postoperative medium term follow-up.

[Left atrial myxoma and isquemic stroke in a child]. / Mixoma atrial esquerdo com acidente vascular cerebral isquêmico em criança.

The authors present a case of left atrial myxoma with stroke in an 8-year-old female child. The tumor was removed and two months after the surgery a left atrial septum mass was observed suggesting recurrence. The child was asymptomatic. Literature review emphasizes the rarity and clinically aggressive behavior of this tumor at this age group and demonstrates rare recurrence rates after surgery.