Parotid gland swelling in primary Sjögren's syndrome: activity and other sialadenosis causes.

OBJECTIVE: To assess the prevalence of parotid gland swelling (PGS) and its association with features of SS and other causes of sialadenosis in a Latin-American cohort of primary SS. METHODS: We included 668 patients from Argentina, Brazil, Mexico and Paraguay. We retrospectively registered demographics, disease duration, oral/ocular symptoms, serology and scored the basal ESSDAI. We defined PGS as a recurrent or persistent increase of volume of any parotid glands during adulthood (self-reported and/or physical examination). We registered the presence of diabetes mellitus, dyslipidaemia, body mass index and alcohol consumption. We used logistic regression analysis reporting odds ratio (OR) and 95% CI. RESULTS: PGS was present in 242 patients (36.2%): 78 previous to SS diagnosis, 86 concomitantly, 73 during follow-up and five unknown. At the multivariate analysis, PGS was associated with RF (OR 2.47, 95% CI: 1.1, 6.5, P = 0.0001), basal articular ESSDAI domain (OR 1.63, 95% CI: 1.01, 2.6, P = 0.04) and alcohol consumption (OR 2.42, 95% CI: 1.41, 4-15). Patients with PGS during the follow-up had a higher prevalence of alcohol consumption (45.3%) compared with the remaining PGS cases (26.8%; OR 2.41 95% CI: 1.2, 4.7), or patients without parotid gland swelling (15.6%; OR 3.8 95% CI: 1.7, 8.2) in all the adjusted models. CONCLUSION: PGS generally precedes or presents concomitantly with SS diagnosis, and is related to RF and articular activity. Alcohol consumption is an additional factor in PGS, especially during follow-up. The meaning of this last finding as well as its prognostic implications remains to be elucidated and deserves further evaluation in prospective studies.

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness.

Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well-being and in reducing psychopathological symptoms commonly experienced by people with chronic illness (CI). Compassion-focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self-criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait-list; treatment as usual). Also, there is an interest in developing cost-effective mental health solutions, such as low-intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four-session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post-intervention comparable to those found in similar studies (around 50%). Intention-to-treat analyses showed that participants presented significantly less illness-related shame, less uncompassionate self-responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3- and 6-month follow-up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post-intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self-responding and less anxiety. Results suggest that low-intensity (four sessions) online ACT and CFT are cost-effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.

Effects of restraining measures due to COVID-19: Pre- and post-lockdown cognitive status and mental health.

The COVID-19 pandemic has prompted all countries to adopt restraining measures to mitigate the spread of the disease. Usually, large-scale disasters tend to be accompanied by significant increases of psychological distress, depression and anxiety. Confinement measures imposed during the COVID-19 pandemic are likely to have similar consequences. In the present study we aim to evaluate how COVID-19 affected the overall psychological functioning of Portuguese individuals by providing a comparison of current data with status prior to the COVID-19 pandemic. The study sample was composed of 150 cognitively healthy participants. Results show an overall maintenance of cognitive capacities, although subjective cognitive decline complaints significantly increased during the pandemic. Regarding mental health, restraining measures culminated in an aggravation of depressive and decrease of the perceived quality of life, associated with feelings of loneliness and perceived social isolation. Finally, higher levels of pre-COVID-19 quality of life seem to play a protective role against depression and anxiety and predict less difficulties in emotion regulation, feelings of solitude and cognitive complaints. In sum, confinement due to COVID-19 implied an aggravation of the mental health of the Portuguese population, which appears to have been attenuated in those with higher pre-pandemic levels of perceived quality of life.

Baseline Pro-inflammatory Diet Is Inversely Associated with Change in Weight and Body Fat 6 Months Following-up to Bariatric Surgery.

OBJECTIVE: To evaluate whether the baseline Dietary Inflammatory Index (DII®) was associated with weight loss and body composition change after bariatric surgery. METHODOLOGY: This longitudinal study included 132 women with obesity (BMI ≥ 35 kg/m2, 43.0 ± 9.7 years), followed up for 6 months after bariatric surgery. The DII® was calculated from dietary data collected using 24-h dietary recall interviews. Anthropometric variables, socio demographic variables, health-related habits, history of disease, as well as gastrointestinal symptoms, both in the preoperative period (baseline) and 6 months after bariatric surgery were collected from the patients' medical records. RESULTS: Individuals with a more pro-inflammatory diet (DII > 0.35 median value) preoperatively experienced smaller weight loss (- 22.7% vs. - 25.3%, p = 0.02) and fat mass loss (- 31.9 vs. - 36.2%, p = 0.026), with no difference in lean mass (p = 0.14). In a linear regression model, the baseline DII score was negatively associated with percentage change in weight and fat mass and positively associated with weight and fat mass in the sixth month after surgery. In addition, a pro-inflammatory baseline DII score was correlated with a lower intake of fruit (r = - 0.26, p = 0.006), vegetables (r = - 0.47, p = 0.001), and legumes (r = - 0.21, p = 0.003) in the postoperative period. CONCLUSION: In this longitudinal study, a pro-inflammatory diet at baseline was associated with smaller reductions in weight and body fat and poorer dietary quality (reduced consumption of fruits, vegetables, and legumes) 6 months after bariatric surgery.

Quality of Life, Family Support, and Comorbidities in Institutionalized Elders With and Without Symptoms of Depression.

The institutionalization of elders can decrease the health status and quality of life in this population. The aim of this study was to analyze the socio-demographic, quality of life, family support, and comorbidities variables in institutionalized elders with and without symptoms of depression. This was a cross-sectional study in institutions for long permanence for the elderly in the State of Rio Grande do Norte, Brazil. Two institutionalized elderly groups were compared (138 elders: 69 with and 69 without depressive symptoms). The instruments used were: mini-mental state examination, geriatric depression scale in the reduced version, socio-demographic questionnaire, quality of life (World Health Organization Quality of Life abbreviated-WHOQOL-bref), and inventory of perception of family support. Elders with depressive symptoms had inferior quality of life than those without depressive symptoms. Other factors that negatively influenced the quality of life in this population include: low economic conditions, occurrence of comorbidities, and deficient family assistance. These results have important implications in the decision making process with regard to strategies for improving the health status of institutionalized elders.

Patient-generated subjective global assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer.

INTRODUCTION: A comparative study of the various methods of nutritional assessment currently available in oncology are necessary to identify the most appropriate one, as well as the relationships that exist among the different instruments. OBJECTIVE: To compare the nutritional diagnosis obtained by the Patient-Generated Subjective Global Assessment (PG-SGA) with the objective anthropometric measurements in the elderly undergoing oncology treatment and to assess the concordance between the methods used in detecting malnutrition. METHODS: A cross-sectional study of the elderly, older than or equal to 60 years in age undergoing oncology treatment. The PG-SGA was performed and the anthropometric parameters including weight, height, Body Mass Index (BMI), arm circumference, arm muscle circumference, corrected arm muscle area, arm fat area, calf circumference, waist circumference, hip circumference, waist-hip ratio and triceps skinfold were evaluated. From a 24-hour recall the energy and macronutrient intakes were estimated. RESULTS: A total of 96 elderly patients were evaluated. The PG-SGA identified 29.2% with moderate malnutrition or suspected malnutrition and 14.6% with severe malnutrition. From among the elderly evaluated, 47.9% required critical nutritional intervention. The anthropometric parameters and the consumption of energy and macronutrients revealed significant differences based on the subjective PG-SGA classification. The prevalence of malnutrition ranged from 43.8% to 61.4%, depending upon the instrument used. The method most consistent with the diagnosis of malnutrition provided by the PGSGA was the BMI (kappa = 0.54; CI: 0.347-0.648). CONCLUSIONS: The PG-SGA showed a significant correlation with the anthropometric measurements and with food consumption for both the categorical classification, as well as for the scoring system. Diagnosis of malnutrition showed variable prevalence depending upon the method used, and none were found equivalent to the PG-SGA.

Introducción: Los estudios comparativos entre los métodos de evaluación nutricional en oncología son necesarios para identificar los medios más adecuados y las relaciones entre los diferentes instrumentos. Objetivos: Comparar el diagnóstico nutricional obtenido por la Valoración Subjetiva Global-Generada por el Paciente (PG-SGA) con mediciones antropométricas objetivas en el tratamiento oncológico sometido ancianos y evaluar la concordancia entre los métodos de detección de la desnutrición. Métodos: Estudio transversal de los ancianos con edad mayor o igual a 60 en tratamiento oncológico. El PG-SGA se realizó y evaluó los parámetros antropométricos: peso, talla, Índice de Masa Corporal (IMC), circunferencia del brazo, circunferencia muscular del brazo, área muscular del brazo corregida, brazo área de grasa, circunferencia de la pantorrilla, circunferencia de la cintura, circunferencia de la cadera, la cinturacadera y pliegue tricipital. Desde un recordatorio de 24 horas se estimaron los consumos de energía y macronutrientes. Resultados: Se evaluaron un total de 96 ancianos. El PG-SGA identificó 29,2% con desnutrición moderada o sospecha de la desnutrición y el 14,6% con desnutrición severa. De las personas mayores evaluados, el 47,9% necesitó una intervención nutricional crítico. Parámetros antropométricos y el consumo de energía y macronutrientes mostraron diferencias significativas en función de la clasificación subjetiva de la PG-SGA. Prevalencia de la desnutrición varió de 43,8% a 61,4%, en función del instrumento utilizado. El método más consistente con el diagnóstico de desnutrición proporcionada por el PG- -SGA fue el índice de masa corporal (kappa = 0,54, IC: 0,347 hasta 0,648). Conclusiones: El PG-SGA mostró una correlación significativa con las mediciones antropométricas y con el consumo de alimentos tanto para la clasificación categórica, así como para el sistema de puntuación. El diagnóstico de la malnutrición mostró prevalencia variable en función del método, y ninguno era equivalente a la PG-SGA.

Surgical treatment of anomalous coronary artery arising from the pulmonary artery.

Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal condition. We report the clinical presentation, surgical treatment and long-term follow-up of seven surgical cases of anomalous left coronary and one case of anomalous right coronary artery arising from the pulmonary artery. Age ranged from 7 months to 13 years (average: 5.09+/-3.7 years) and weight ranged from 7 to 50 kg (average: 19.9+/-8.8 kg). Follow-up was 100% complete: average 78 months (S.D.: 52.7 months). Direct reimplantation was the surgical technique in six cases, Takeuchi procedure in one case and subclavian artery interposition in one case. Concomitant mitral valve repair was undertaken in two cases. In two children the coronary artery anomaly was diagnosed and treated only after a first surgery for other congenital heart anomaly. Left ventricle ejection fraction was restored in those cases of pre-operative dysfunction. Mortality was not observed and all children are asymtomatic and free of reoperation.

Mid-to-long term follow-up after surgical repair of atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot.

OBJECTIVES: Our aim is to describe our surgical approach in dealing with patients having atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot over the last 8 years, and to present our results in mid-to-long term follow-up. METHODS: Between November 1995 and January 2004, we performed surgical correction in 8 consecutive children with atrioventricular septal defect, common atrioventricular junction, interventricular shunting, and associated tetralogy of Fallot. The age at surgical correction varied from 8 months to 20 years, with a mean of 45 months, and standard deviation of 74 months. A palliative systemic-to-pulmonary shunt had previously been performed in 3 patients. Follow-up ranged from 57 to 135 months, with a mean of 93.5 months, and standard deviation of 32 months. We used a two-patch technique to repair of the atrioventricular septal defect, and a pericardial transjunctional patch for relief of the obstruction in the right ventricular outflow tract. RESULTS: There were no deaths, nor reoperations either in the postoperative period or during follow-up. All patients are asymptomatic, or in the second class created by the New York Heart Association. The mean period of cardiopulmonary by-pass was 136 minutes, and the mean stay in hospital was 11.8 days. At the last examination, pulmonary valvar insufficiency was considered severe in 2 patients, and moderate in another 2. No patient developed more than a trace of regurgitation across the reconstituted left atrioventricular valve. CONCLUSIONS: The two-patch technique, associated with ventriculotomy and a transjunctional pulmonary patch is safe and efficient when correcting atrioventricular septal defect associated with tetralogy of Fallot, resulting in good mid-to-long term clinical outcomes.

Minimally invasive thoracotomy (muscle-sparing thoracotomy) for occlusion of ligamentum arteriosum (ductus arteriosus) in preterm infants.

OBJECTIVES: To analyze the feasibility, the safety, and the primary outcomes of a minimally invasive thoracotomy for the occlusion of ligamentum arteriosum (ductus arteriosus) in preterm infants. METHODS: Between October 1991 and June 2003, 273 preterm infants and very low birth weight preterm infants were submitted to a surgical occlusion of the ligamentum arteriosum (ductus arteriosus) through muscle-sparing thoracotomy under general anesthesia in the neonatal ICU. Pre-operative demographic data, mortality outcomes, and adverse events were retrospectively analyzed through medical records consultation. RESULTS: There were no deaths related to surgery, and 234 (86%) patients were discharged from hospital. Thirty-nine deaths have occurred between the 1st and the 51st days. The cause of death was sepsis (14 patients); intracranial bleeding (11 patients); and necrotizing enterocolitis (9 patients). All causes were related to prematurity. In five patients the cause of death was not established or could not be found in the medical records. The most frequent adverse events related to the surgery were: pneumothorax: 3.3% (9 patients), bleeding: 1.4% (4 patients). CONCLUSIONS: The minimally invasive thoracotomy technique for the occlusion of the ligamentum arteriosum (ductus arteriosus) when performed in preterm infants and very low birth weight infants is feasible, safe, efficient, related to low morbidity, and not dependent of hospital resources.

Surgical treatment of complete atrioventricular septal defect with the two-patch technique: early-to-mid follow-up.

We report our results on surgical treatment of complete atrioventricular septal defects using the two-patch technique. Forty patients with complete atrioventricular septal defects were operated on in the period from November 1995 to January 2004 and retrospectively analyzed. The age at the time of surgery ranged from 4 months to 20 years (average=18.8+/-37 months). Their weights ranged from 3 to 39 kg (average=7.6+/-5.8 kg). Associated tetralogy of Fallot was present in 20% of the cases (8 patients). Monitoring was complete until January 2007, corresponding to a follow-up ranging from 36 to 135 months (average=74+/-33.7 months). The surgical mortality rate was 2.5% and the hospital mortality rate was 5%. A third patient died from a brain abscess two years after surgery. Over the long-term, two patients needed further operations: one was submitted to mitral plasty due to severe residual mitral insufficiency, one year later; the other underwent a resection of a sub-aortic membrane after three years. Differences were evaluated using the Student-t or Mann-Whitney tests. Surgical treatment of complete atrioventricular septal defect using the two-patch technique results in low morbidity and mortality in early-to-mid term follow-up.

Toracotomia minimamente invasiva (miopreservadora) para ligadura do canal arterial em prematuros / Minimally invasive thoracotomy (muscle-sparing thoracotomy) for occlusion of ductus arteriosus in preterm infants

Objetivo: Avaliar a aplicabilidade, segurança e resultados iniciais da toracotomia minimamente invasiva para ligadura do canal arterial em prematuros. Métodos: Entre outubro de 1991 e julho de 2003, 273 prematuros e prematuros extremos foram submetidos à ligadura cirúrgica do canal arterial por toracotomia miopreservadora, com anestesia geral, em UTI neonatal...

Norepinephrine-evoked pain in fibromyalgia. A randomized pilot study [ISRCTN70707830].

BACKGROUND: Fibromyalgia syndrome displays sympathetically maintained pain features such as frequent post-traumatic onset and stimuli-independent pain accompanied by allodynia and paresthesias. Heart rate variability studies showed that fibromyalgia patients have changes consistent with ongoing sympathetic hyperactivity. Norepinephrine-evoked pain test is used to assess sympathetically maintained pain syndromes. Our objective was to define if fibromyalgia patients have norepinephrine-evoked pain. METHODS: Prospective double blind controlled study. PARTICIPANTS: Twenty FM patients, and two age/sex matched control groups; 20 rheumatoid arthritis patients and 20 healthy controls. Ten micrograms of norepinephrine diluted in 0.1 ml of saline solution were injected in a forearm. The contrasting substance, 0.1 ml of saline solution alone, was injected in the opposite forearm. Maximum local pain elicited during the 5 minutes post-injection was graded on a visual analog scale (VAS). Norepinephrine-evoked pain was diagnosed when norepinephrine injection induced greater pain than placebo injection. Intensity of norepinephrine-evoked pain was calculated as the difference between norepinephrine minus placebo-induced VAS scores. RESULTS: Norepinephrine-evoked pain was seen in 80 % of FM patients (95% confidence intervals 56.3 - 94.3%), in 30 % of rheumatoid arthritis patients and in 30 % of healthy controls (95% confidence intervals 11.9 - 54.3) (p < 0.05). Intensity of norepinephrine-evoked pain was greater in FM patients (mean +/- SD 2.5 +/- 2.5) when compared to rheumatoid arthritis patients (0.3 +/- 0.7), and healthy controls (0.3 +/- 0.8) p < 0.0001. CONCLUSIONS: Fibromyalgia patients have norepinephrine-evoked pain. This finding supports the hypothesis that fibromyalgia may be a sympathetically maintained pain syndrome.

Síndrome de Möbius: relato de caso / Möbius syndrome: case report

As autoras apresentam um caso clínico da síndrome de Möbius numa criança de 4 anos de idade, com antecedentes familiares, porém sem laços de consangüinidade entre os pais, sugerindo participar dos casos esporádicos de etiologia desconhecida, cuja recorrência foi prevista em 72 por cento. Trata-se de uma síndrome extremamente rara, näo progressiva, em que o paciente apresenta desde alteraçöes faciais até a ausência de pé e mäo

Angioplastia de aorta distal e artérias ilíaca, femoral, poplítea, renal e subclávia: resultados imediatos e tardios / Distal aorta, femoral, poplietal, renal and subclavian percutaneous transluminal angioplasty. early and late results

Estudar os resultados da angioplastia periférica a longo prazo. Entre agosto de 1981 e agosto de 1989 foram aplicadas 33 angioplastias periféricas em 27 pacientes. Houve sucesso em 29 procedimentos, dilataçäo insuficiente em 1 e falha de passagem nos demais 3,2 dos quais submetidos a novo procedimento com modificaçäo técnica ou outra via de acesso, obtendo'se em ambos sucesso. Houve portanto sucesso em 88% dos procedimentos e atingiu'se o objetivo em 25 (93%) dos pacientes. Foram dilatadas 34 obstruçöes, sendo 12 em artéria renal, 12 em ilíaca primitiva; 4 em ilíaca externa, 3 em femoral superficial, 1 em poplítea, 1 em subclávia e, finalmente, 1 em poplítea, 1 em aorta distal. Na evoluçäo, houve uma reestenose de artéria renal, que foi redilatada, 1 oclusäo de ilíaca primitiva representando 9% das dilataçöes de ilíaca primitiva e 6% do total de obstruçöes de ilíacas dilatadas e oclusäo de poplítea. No geral, das 34 obstruçöes dilatadas, tivemos uma patência até de 2 meses de 91%. A angioplastia periférica mostrou-se método efetivo, com alívio sintomático epersistência dos bons resultados a longo prazo

Angioplastia transluminal percutânea da arteria subclávia esquerda em um paciente com síndrome do roubo coronária-subclávia / Percutaneous transluminal angioplasty of left subclavian artery in patient with coronary-subclavian steal syndrome

Os autores apresentam o caso de um paciente submetido a cirurgia de revascularizaçäo miocárdica há 10 anos com anastomose da artéria mamária interna esquerda-artéria coronária descendente anterior e que há cerca de 2 meses voltou a apresentar dor precordial típica progressiva. Foi realizado estudo hemodinâmico que revelou anastomose mamária-coronária patente e lesäo obstrutiva severa da artéria subclávica esquerda, caracterizando-se assim a síndrome do roubo coronária-subclávia. O paciente foi entäo submetido a angioplastia transluminal percutânea da artéria subclávia esquerda com sucesso ocorrendo remissäo dos sintomas. Obteve-se o acompanhamento clínico do paciente, assintomático do ponto de vista cardiológico por 1 ano e 8 meses, quando entäo veio a falecer em decorrência de acidente vascular encefálico. Os autores recomendam atençäo especial as lesöes obstrutivas das artérias subclávias, com a realizaçäo de estudo angiográfico dos troncos supra-aórticos, especialmente naqueles pacientes com doença aterosclerótica difusa e/ou sinais de doença isquêmica cérebro-vascular e dos membros superiores, seja em pacientes que iräo submeter-se a cinecoronariografia e que potencialmente poderäo ter utilizadas as artérias mamárias para revascularizaçäo miocárdica, seja em pacientes submetidos a cirurgia de revascularizaçäo com o uso da artéria mamária e que voltam a apresentar angor e que no reestudo angiográfico mostram a anastomose patente

Manuseio do canal arterial patente no prematuro com síndrome de angústia respiratória: ligadura ou indometacina? / Management of persistent ductus arteriosus in premature infants with respiratory distress syndrome: ligation or indomethacin?

A presença de canal arterial patente (PCA) com grande shunt sistêmico-pulmonar no prematuro com síndrome de angústia respiratória (SAR) está quase sempre associada a insuficiência cardíaca, displasia bronco pulmonar, enterocolite necrotizante, hemorragia intracraniana e morte. A ligadura do canal melhora a complacência pulmonar, reduz, significativamente, o tempo de assistência ventilatória e melhora o estado geral do paciente. Depois da introduçao, nesta última década, da indometacina para a interrupçao do PCA, no prematuro, vários estudos vêm procurando estabelecer as vantagens de uma forma de tratamento sobre a outra. O propósito do nosso estudo é comparar os resultados obtidos em 48 pacientes (pts) (Grupo 1) submetidos a ligadura cirúrgica, nos últimos 8 anos, com 28 pts. (Grupo 2) nos quais a indometacina foi, preferentemente, utilizada. A idade gestacional média do Grupo 1 foi de 29,13 + 2,33 semanas (24-34) e de 28,39 + 2,30 semanas (25-32) no Grupo 2. O peso médio foi de 954,17 + 220,68 g (540-1750 g) no Grupo 1 e de 923,21 + 191,74 g (550-1400 g) no Grupo 2. Trinta e três (60,75 por cento) dos pts. do Grupo 1 eram menores do que 1000 g (prematuros extremos), enquanto que 21 do Grupo 2 (75,0 por cento) estavam nessa condiçao. Nove pacientes (32,1 por cento) do Grupo 2 foram transferidos para o Grupo 1, devido ao insucesso da terapêutica com a indometacina, ou pela intolerância às doses indicadas. A ligadura foi realizada na própria unidade de terapia intensiva em 31 pts. (64,5 por cento). A técnica empregada tem sido a de uma toracotomia póstero-lateral pequena, com preservaçao dos músculos do tórax e abertura pelo 3( ou 4( espaço intercostal. Por via extrapleural, o canal é alcançado e ligado com dois clips metálicos, inicialmente, o tórax era rotineiramente drenado, apenas quando havia abertura da pleura. Mais recentemente, mesmo com a pleura aberta, somente sao drenados os casos que apresentam pneumotórax prévio, ou entao sangramento excessivo. A mortalidade no Grupo 1 foi de 18,75 por cento (9 pts.) e, no Grupo 2, de 25,0 por cento (7 pts.). Quatro pacientes do Grupo 2 transferidos para o Grupo 1 faleceram. As causas de óbito no Grupo 1 foram sépsis e hemorragia intracraniana; no Grupo 2, sépsis, enterocolite necrotizante com perfuraçao localizada, hemorragia intracraniana e pneumotórax. Nos dois grupos, a mortalidade foi significantemente maior nos prematuros extremos. A despeito dos problemas de comparaçao entre os 2 grupos e das conclusoes limitadas que podem ser retiradas de um estudo retrospectivo e nao randomizaçao, acreditamos que os resultados da ligadura cirurgica sao nitidamente superiores aos obtidos com o uso da indometacina.

Trombólise no infarto agudo do miocárdio: aspectos clínicos e sequência terapêutica / Thrombolysis in acute myocardial infarction: clinical and therapeutic aspects

Foram estudados 32 pacientes com infarto agudo do miocárdio, submetidos a infusäo venosa de estreptoquinase (SK). Os pacientes foram divididos em dois grupos, de acordo com o intervalo entre o início dos sintomas e a administraçäo da SK (Delta t). O grupo I com Delta T menor ou igual a 4 horas apresentou o índice de reperfusäo de 85,7% e o grupo II com Delta t superior a 4 horas teve 81,8% de vasos recanalizados. Procedimentos seqüências ao uso do trombolítico configuram-se como: a) angioplastia percutânea transluminal coronária (APTC) em dez pacientes, b) cirurgia de revascularizaçäo miocárdica (RM) em outros dez pacientes. A mortalidade hospitalar foi de 3,1%. Näo houve complicaçöes graves ao uso da SK. O uso da SK - IV parece ser seguro e eficaz como parte do tratamento em pacientes com infarto agudo do miocárdio com menos de 6 horas de evoluçäo

Angioplastia transluminal percutânea na regiäo da bifurcaçäo aórtica: técnica do duplo baläo / Aortic bifurcation percutaneous transluminal angioplasty: kissing ballon technique

Os autores apresentam um caso bem sucedido de angioplastia transluminal percutânea da regiäo da bifurcaçäo aórtica utilizando a técnica de DUPLO BALAO ('KISSING BALLON') em um paciente com grave doença aterosclerótica difusa, tendo inclusive se submetido a cirurgia de revascularizaçäo miocárdica um ano antes do procedimento. Esta técnica é de execuçäo relativamente simples, segura, durável e tem se mostrado como uma alternativa a ser considerada em relaçäo a cirurgia, especialmente em pacientes com doença aterosclerótica difusa e/ou com complicaçöes clínicas, que implicariam em um risco aumentado em relaçäo ao procedimento cirúrgico