Congestive Hepatopathy Secondary to Right Ventricular Hypertrophy Related to Monocrotaline-Induced Pulmonary Arterial Hypertension.

Heart dysfunction and liver disease often coexist. Among the types of cardiohepatic syndrome, Type 2 is characterized by the chronic impairment of cardiac function, leading to chronic liver injury, referred to as congestive hepatopathy (CH). In this study, we aimed to establish a rat model of CH secondary to right ventricular hypertrophy (RVH) related to monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Fifty male Wistar rats were divided into four groups and randomly assigned to control and experimental groups. Three experimental groups were submitted to intraperitoneal MCT inoculation (60 mg/kg) and were under its effect for 15, 30 and 37 days. The animals were then sacrificed, obtaining cardiac and hepatic tissues for anatomopathological and morphometric analysis. At macroscopic examination, the livers in the MCT groups presented a nutmeg-like appearance. PAH produced marked RVH and dilatation in the MCT groups, characterized by a significant increase in right ventricular free wall thickness (RVFWT) and chamber area. At histological evaluation, centrilobular congestion was the earliest manifestation, with preservation of the hepatocytes. Centrilobular hemorrhagic necrosis was observed in the groups exposed to prolonged MCT. Sinusoidal dilatation was markedly increased in the MCT groups, quantified by the Sinusoidal Lumen Ratio (SLR). The Congestive Hepatic Fibrosis Score and the Centrilobular Fibrosis Ratio (CFR) were also significantly increased in the MCT30 group. Hepatic atrophy, steatosis, apoptotic bodies and, rarely, hydropic swelling were also observed. SLR correlated strongly with CFR and RVFWT, and CFR correlated moderately with RVFWT. Our rat model was able to cause CH, related to monocrotaline-induced PAH and RVH; it was feasible, reproducible, and safe.

SOFTWARE-ASSISTED IMAGE ANALYSIS FOR IDENTIFICATION AND QUANTIFICATION OF HEPATIC SINUSOIDAL DILATATION AND CENTRILOBULAR FIBROSIS.

BACKGROUND: Heart dysfunction and liver disease often coexist because of systemic disorders. Any cause of right ventricular failure may precipitate hepatic congestion and fibrosis. Digital image technologies have been introduced to pathology diagnosis, allowing an objective quantitative assessment. The quantification of fibrous tissue in liver biopsy sections is extremely important in the classification, diagnosis and grading of chronic liver disease. AIM: To create a semi-automatic computerized protocol to quantify any amount of centrilobular fibrosis and sinusoidal dilatation in liver Masson's Trichrome-stained specimen. METHOD: Once fibrosis had been established, liver samples were collected, histologically processed, stained with Masson's trichrome, and whole-slide images were captured with an appropriated digital pathology slide scanner. After, a random selection of the regions of interest (ROI's) was conducted. The data were subjected to software-assisted image analysis (ImageJ®). RESULTS: The analysis of 250 ROI's allowed to empirically obtain the best application settings to identify the centrilobular fibrosis (CF) and sinusoidal lumen (SL). After the establishment of the colour threshold application settings, an in-house Macro was recorded to set the measurements (fraction area and total area) and calculate the CF and SL ratios by an automatic batch processing. CONCLUSION: Was possible to create a more detailed method that identifies and quantifies the area occupied by fibrous tissue and sinusoidal lumen in Masson's trichrome-stained livers specimens.

Software-assisted image analysis for identification and quantification of hepatic sinusoidal dilatation and centrilobular fibrosis / Análise da imagem histológica assistida por software para identificação e quantificação de dilatação sinusoidal e fibrose hepática centrolubular

ABSTRACT Background: Heart dysfunction and liver disease often coexist because of systemic disorders. Any cause of right ventricular failure may precipitate hepatic congestion and fibrosis. Digital image technologies have been introduced to pathology diagnosis, allowing an objective quantitative assessment. The quantification of fibrous tissue in liver biopsy sections is extremely important in the classification, diagnosis and grading of chronic liver disease. Aim: To create a semi-automatic computerized protocol to quantify any amount of centrilobular fibrosis and sinusoidal dilatation in liver Masson's Trichrome-stained specimen. Method: Once fibrosis had been established, liver samples were collected, histologically processed, stained with Masson's trichrome, and whole-slide images were captured with an appropriated digital pathology slide scanner. After, a random selection of the regions of interest (ROI's) was conducted. The data were subjected to software-assisted image analysis (ImageJ®). Results: The analysis of 250 ROI's allowed to empirically obtain the best application settings to identify the centrilobular fibrosis (CF) and sinusoidal lumen (SL). After the establishment of the colour threshold application settings, an in-house Macro was recorded to set the measurements (fraction area and total area) and calculate the CF and SL ratios by an automatic batch processing. Conclusion: Was possible to create a more detailed method that identifies and quantifies the area occupied by fibrous tissue and sinusoidal lumen in Masson's trichrome-stained livers specimens.

Resumo Racional: Tecnologias de imagem digital têm sido introduzidas ao diagnóstico patológico, permitindo avaliações quantitativas objetivas. A quantificação de tecido fibroso em biópsias de fígado é extremamente importante para a classificação, diagnóstico e graduação de doenças crônicas hepáticas. Objetivo: Criar um protocolo computadorizado semi-automático para quantificação de fibrose centrolobular e dilatação sinusoidal em amostras de fígado coradas por Tricrômico de Masson. Método: Uma vez instaurada a fibrose, amostras de fígado foram coletadas, processadas histologicamente, coradas por Tricrômico de Masson e WSI (Whole Slide Images) foram capturadas por scanner digital patológico apropriado. Uma seleção aleatória das regiões de interesse (ROI) foi realizada. Os dados foram submetidos a uma análise de imagem assistida por software (ImageJ®). Resultados: A análise de 250 ROIs permitiu obter-se empiricamente as melhores configurações capazes de identificar fibrose centrolobular (FC) e lúmen sinusoidal (LS). Após o estabelecimento das configurações de padrão de cor, uma Macro de autoria própria foi gravada para definir as medidas (área da fração e área total) e calcular as razões de FC e LS por processamento em grupo/lote (batch mode). Conclusão: Foi possível criar um método detalhado capaz de identificar e quantificar a área ocupada por tecido fibroso e lúmen sinusoidal em espécimes de fígado coradas por Tricrômico de Masson.

CARVEDILOL AS PRIMARY PROPHYLAXIS FOR GASTRIC VARICEAL BLEEDING IN PORTAL HYPERTENSION MODEL IN RATS.

BACKGROUND: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. AIM: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. METHOD: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. RESULTS: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. CONCLUSION: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

Plexiform Lesions in an Experimental Model of Monocrotalin-Induced Pulmonary Arterial Hypertension. / Lesões Plexiformes em Modelo Experimental de Hipertensão Arterial Pulmonar Induzida por Monocrotalina.

BACKGROUND: The monocrotaline (MCT)-induced pulmonary arterial hypertension model is one of the most reproduced today, presenting as a limitation the absence of plexiform lesions, typical manifestations of the severe disease in humans. OBJECTIVE: To evaluate the severity of MCT-induced pulmonary arteriopathy by pathological findings of lung and heart tissue samples, clinical course and 37-day survival. METHODS: Fifty male Wistar rats were divided into one of the four groups - control (CG) (n = 10) and three intervention (MCT) groups. The MCT groups received intraperitoneal injection (60 mg/kg) of MCT and remained exposed to the substance for 15 days (G15, n = 10), 30 days (G30, n = 10) and 37 days (G37, n = 20). At the end of each period, the animals were sacrificed, and pulmonary and cardiac tissues were collected for anatomopathological and morphometric analysis. The Kruskal-Wallis test was used, considering a level of significance of 5%. RESULTS: In the lungs of MCT animals, lesions related to pulmonary arteriopathy were found, including muscularization of the arterioles, hypertrophy of the middle layer and concentric neointimal lesions. Complex lesions were observed in MCT groups, described as plexiform and plexiform-like lesions. Right ventricular hypertrophy was evidenced by increased thickness and diameter of the cardiomyocytes and a significant increase in the right ventricular wall thickness (p <0.0000). CONCLUSION: The MCT model was able to generate moderate-severe pulmonary arteriopathy associated with secondary right ventricular hypertrophy. The 37-day survival rate was 50%. To our knowledge, this study was the first to note the presence of complex vascular lesions, similar to those observed in patients with severe pulmonary arterial hypertension, in an isolated MCT model. (Arq Bras Cardiol. 2020; 115(3):480-490).

FUNDAMENTO: O modelo de hipertensão arterial pulmonar induzida por monocrotalina (MCT) é um dos mais reproduzidos atualmente, apresentando como limitação a ausência de lesões plexiformes, manifestações típicas da doença grave em humanos. OBJETIVO: Avaliar a gravidade da arteriopatia pulmonar induzida por MCT por meio dos achados anatomopatológicos pulmonares e cardíacos, evolução clínica e sobrevida em 37 dias. MÉTODOS: Foram utilizados 50 ratos machos Wistar divididos em quatro grupos, sendo um controle (n = 10). Os três grupos restantes foram submetidos à inoculação de MCT (60 mg/kg i.p.) e ficaram sob o seu efeito por 15 (n = 10), 30 (n = 10) e 37 dias (n = 20). Ao final de cada período, os animais foram sacrificados, obtendo-se tecidos pulmonar e cardíaco para análise anatomopatológica e morfométrica. Empregou-se o teste Kruskal-Wallis, considerando nível de significância de 5%. RESULTADOS: Nos pulmões dos animais MCT foram constatadas lesões referentes à arteriopatia pulmonar, incluindo muscularização das arteríolas, hipertrofia da camada média e lesões neointimais concêntricas. Lesões complexas foram observadas nos grupos MCT, descritas como plexiforme e do "tipo" plexiforme (plexiform-like). A hipertrofia do ventrículo direito foi constatada pelo aumento da espessura e diâmetro dos cardiomiócitos e pelo aumento significativo da espessura da parede do ventrículo direito (p<0,0000). CONCLUSÃO: O modelo foi capaz de gerar arteriopatia pulmonar moderada-grave associada à hipertrofia do ventrículo direito secundária, com sobrevida de 50% em 37 dias. De nosso conhecimento, este estudo foi o primeiro a constatar a presença de lesões vasculares complexas, semelhantes às observadas em pacientes com hipertensão arterial pulmonar grave, em modelo isolado de MCT. (Arq Bras Cardiol. 2020; 115(3):480-490).

Lesões Plexiformes em Modelo Experimental de Hipertensão Arterial Pulmonar Induzida por Monocrotalina / Plexiform Lesions in an Experimental Model of Monocrotalin-Induced Pulmonary Arterial Hypertension

Resumo Fundamento O modelo de hipertensão arterial pulmonar induzida por monocrotalina (MCT) é um dos mais reproduzidos atualmente, apresentando como limitação a ausência de lesões plexiformes, manifestações típicas da doença grave em humanos. Objetivo Avaliar a gravidade da arteriopatia pulmonar induzida por MCT por meio dos achados anatomopatológicos pulmonares e cardíacos, evolução clínica e sobrevida em 37 dias. Métodos Foram utilizados 50 ratos machos Wistar divididos em quatro grupos, sendo um controle (n = 10). Os três grupos restantes foram submetidos à inoculação de MCT (60 mg/kg i.p.) e ficaram sob o seu efeito por 15 (n = 10), 30 (n = 10) e 37 dias (n = 20). Ao final de cada período, os animais foram sacrificados, obtendo-se tecidos pulmonar e cardíaco para análise anatomopatológica e morfométrica. Empregou-se o teste Kruskal-Wallis, considerando nível de significância de 5%. Resultados Nos pulmões dos animais MCT foram constatadas lesões referentes à arteriopatia pulmonar, incluindo muscularização das arteríolas, hipertrofia da camada média e lesões neointimais concêntricas. Lesões complexas foram observadas nos grupos MCT, descritas como plexiforme e do "tipo" plexiforme (plexiform-like). A hipertrofia do ventrículo direito foi constatada pelo aumento da espessura e diâmetro dos cardiomiócitos e pelo aumento significativo da espessura da parede do ventrículo direito (p<0,0000). Conclusão O modelo foi capaz de gerar arteriopatia pulmonar moderada-grave associada à hipertrofia do ventrículo direito secundária, com sobrevida de 50% em 37 dias. De nosso conhecimento, este estudo foi o primeiro a constatar a presença de lesões vasculares complexas, semelhantes às observadas em pacientes com hipertensão arterial pulmonar grave, em modelo isolado de MCT. (Arq Bras Cardiol. 2020; 115(3):480-490)

Abstract Background The monocrotaline (MCT)-induced pulmonary arterial hypertension model is one of the most reproduced today, presenting as a limitation the absence of plexiform lesions, typical manifestations of the severe disease in humans. Objective To evaluate the severity of MCT-induced pulmonary arteriopathy by pathological findings of lung and heart tissue samples, clinical course and 37-day survival. Methods Fifty male Wistar rats were divided into one of the four groups - control (CG) (n = 10) and three intervention (MCT) groups. The MCT groups received intraperitoneal injection (60 mg/kg) of MCT and remained exposed to the substance for 15 days (G15, n = 10), 30 days (G30, n = 10) and 37 days (G37, n = 20). At the end of each period, the animals were sacrificed, and pulmonary and cardiac tissues were collected for anatomopathological and morphometric analysis. The Kruskal-Wallis test was used, considering a level of significance of 5%. Results In the lungs of MCT animals, lesions related to pulmonary arteriopathy were found, including muscularization of the arterioles, hypertrophy of the middle layer and concentric neointimal lesions. Complex lesions were observed in MCT groups, described as plexiform and plexiform-like lesions. Right ventricular hypertrophy was evidenced by increased thickness and diameter of the cardiomyocytes and a significant increase in the right ventricular wall thickness (p <0.0000). Conclusion The MCT model was able to generate moderate-severe pulmonary arteriopathy associated with secondary right ventricular hypertrophy. The 37-day survival rate was 50%. To our knowledge, this study was the first to note the presence of complex vascular lesions, similar to those observed in patients with severe pulmonary arterial hypertension, in an isolated MCT model. (Arq Bras Cardiol. 2020; 115(3):480-490)

Carvedilol as primary prophylaxis for gastric variceal bleeding in portal hypertension model in rats / Carvedilol como profilaxia de sangramento em varizes gástricas em modelo de hipertensão portal em ratos

ABSTRACT Background: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. Aim: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. Method: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. Results: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. Conclusion: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

RESUMO Racional: A hipertensão portal (HP), medida indiretamente através do gradiente pressórico da veia hepática >5 mmHg, tem como principal causa etiológica a cirrose. Possui como complicações a ascite, disfunção hepática, disfunção renal e varizes esofagogástricas, que caracterizam o quadro de gastropatia. Objetivo: Avaliar o uso do carvedilol como profilaxia primária no desenvolvimento da circulação colateral em ratos submetidos ao modelo de ligadura parcial de veia porta (LPVP). Método: Estudo experimental qualitativo e quantitativo no qual foram utilizados 32 ratos Wistar, divididos em quatro grupos (n=8): grupo I - cirrose + carvedilol (LPVP+C); grupo II - cirrose + veículo (LPVP); grupo III - controle + carvedilol (SO - sham-operated+C); grupo IV - controle + veículo (SO - sham-operated). Após transcorridos sete dias do procedimento cirúrgico, foi administrado carvedilol (10 mg/kg) e veículo (1mL) para os respectivos grupos por sete dias consecutivos. Resultados: A análise histológica não mostrou alteração hepática em nenhum grupo e diminuição de edema e vasodilatação no grupo LPVP+C. A avaliação laboratorial da função hepática não mostrou alteração com significância estatística entre os grupos. Conclusão: Carvedilol mostrou ser fármaco com efeito positivo no sangramento das varizes gástricas e sem efeitos adversos significantes.

RELATIONSHIP BETWEEN ESOPHAGITIS GRADES AND HELICOBACTER PYLORI.

Background: The Helicobacter pylori infection (HP) is related to the development of gastric lesions and lymphoma; however, it is not known if there is a relation with gastroesophageal reflux disease and reflux esophagitis. Aim: To evaluate HP's relationship with esophagitis in patients undergoing upper endoscopy. Methods: Observational, retrospective and cross-sectional study, being evaluated 9576 patients undergoing outpatient endoscopic examination during the period between January and December 2015. Were included patients with any esophageal alteration at the examination; greater than 18; of both genders; independent of the complaint or the reason for the examination, illness or drug use. Were excluded those with active bleeding during the examination and in use of anticoagulants. The variables gender, age, esophagitis and result of the urease test, were studied. For statistical analysis was used the Epi Info software 7.1.5.2. Results: Most of the samples consisted of women and the overall average age was 46.54±16.32 years. The presence of infection was balanced for gender: 1204 (12.56%) women and 952 (13.92%) men. Relating degree of esophagitis HP- and HP+ was observed that the type A was the most common (58.79%, n=1460); 604 (24.32%) had grade B; 334 (13.45%) grade C, and 85 (3.42%) grade D. In the relation between the grade of esophagitis with gender, esophagitis A was predominant in women and present in 929 (63.33%), followed by type B, 282 (46.68%), 136 C (40.71%) and D 30 (35.29%). In men 531 (36.36%) showed type A, 322 (53.31%) B, 198 (59.28%) C, and 55 (64.70%) D. Among the groups 40-50 and over 60 years there was a significant difference in whether have or not have HP+. Conclusion: There is no significant difference between HP infection and the different grades of esophagitis.

Racional: A infecção pelo Helicobacter pylori (HP) é relacionada com o desenvolvimento de lesões e linfoma gástricos; porém, ainda não se sabe ao certo se há relação dele com a doença do refluxo gastroesofágico e esofagite de refluxo. Objetivo: Avaliar a relação do HP com as esofagites em pacientes submetidos à endoscopia digestiva alta. Métodos: Estudo observacional, retrospectivo e transversal, sendo avaliados 9576 pacientes submetidos ao exame endoscópico ambulatorial durante o período compreendido entre janeiro e dezembro de 2015. Foram incluídos pacientes que apresentaram alguma alteração esofágica ao exame; maiores que 18 anos; de ambos os gêneros; independente da queixa ou da razão para a realização do exame, doença ou uso de medicamentos. Excluíram-se os com sangramento ativo durante o exame e em uso de anticoagulantes. Foram avaliadas as variáveis gênero, idade, esofagite e resultado do teste da urease. Para a análise estatística utilizou-se o software Epi Info 7.1.5.2. Resultados: A maioria das amostras foi composta por mulheres e a idade média geral foi de 46,54±16,32 anos. A presença da infecção foi equilibrada para a variável gênero: 1204 (12,56%) mulheres e 952 (13,92%) homens. Relacionando os graus da esofagite com HP+ e HP- observou-se que o tipo A foi o mais comum (58,79% da amostra, n=1460), que 604 (24,32%) possuíam o grau B; 334 (13,45%) o grau C e 85 (3,42%) o grau D. Já na relação entre os graus de esofagite com o gênero, a esofagite A foi predominante nas mulheres e presente em 929 (63,33%), seguido pelo tipo B, com 282 (46,68%), C com 136 (40,71%) e D com 30 (35,29%) mulheres. Nos homens 531 (36,36%) apresentam o tipo A, 322 (53,31%) o B, 198 (59,28%) o C e 55 (64,70%) o D. Entre os grupos de 40 a 50 anos e acima de 60 anos houve diferença significativa em ter ou não HP+. Conclusão: Não há diferença significativa entre infecção por HP nos diferentes graus de esofagite.

Relationship between esophagitis grades and helicobacter pylori / Relação entre graus de esofagite e o helicobacter pylori

ABSTRACT Background: The Helicobacter pylori infection (HP) is related to the development of gastric lesions and lymphoma; however, it is not known if there is a relation with gastroesophageal reflux disease and reflux esophagitis. Aim: To evaluate HP's relationship with esophagitis in patients undergoing upper endoscopy. Methods: Observational, retrospective and cross-sectional study, being evaluated 9576 patients undergoing outpatient endoscopic examination during the period between January and December 2015. Were included patients with any esophageal alteration at the examination; greater than 18; of both genders; independent of the complaint or the reason for the examination, illness or drug use. Were excluded those with active bleeding during the examination and in use of anticoagulants. The variables gender, age, esophagitis and result of the urease test, were studied. For statistical analysis was used the Epi Info software 7.1.5.2. Results: Most of the samples consisted of women and the overall average age was 46.54±16.32 years. The presence of infection was balanced for gender: 1204 (12.56%) women and 952 (13.92%) men. Relating degree of esophagitis HP- and HP+ was observed that the type A was the most common (58.79%, n=1460); 604 (24.32%) had grade B; 334 (13.45%) grade C, and 85 (3.42%) grade D. In the relation between the grade of esophagitis with gender, esophagitis A was predominant in women and present in 929 (63.33%), followed by type B, 282 (46.68%), 136 C (40.71%) and D 30 (35.29%). In men 531 (36.36%) showed type A, 322 (53.31%) B, 198 (59.28%) C, and 55 (64.70%) D. Among the groups 40-50 and over 60 years there was a significant difference in whether have or not have HP+. Conclusion: There is no significant difference between HP infection and the different grades of esophagitis.

RESUMO Racional: A infecção pelo Helicobacter pylori (HP) é relacionada com o desenvolvimento de lesões e linfoma gástricos; porém, ainda não se sabe ao certo se há relação dele com a doença do refluxo gastroesofágico e esofagite de refluxo. Objetivo: Avaliar a relação do HP com as esofagites em pacientes submetidos à endoscopia digestiva alta. Métodos: Estudo observacional, retrospectivo e transversal, sendo avaliados 9576 pacientes submetidos ao exame endoscópico ambulatorial durante o período compreendido entre janeiro e dezembro de 2015. Foram incluídos pacientes que apresentaram alguma alteração esofágica ao exame; maiores que 18 anos; de ambos os gêneros; independente da queixa ou da razão para a realização do exame, doença ou uso de medicamentos. Excluíram-se os com sangramento ativo durante o exame e em uso de anticoagulantes. Foram avaliadas as variáveis gênero, idade, esofagite e resultado do teste da urease. Para a análise estatística utilizou-se o software Epi Info 7.1.5.2. Resultados: A maioria das amostras foi composta por mulheres e a idade média geral foi de 46,54±16,32 anos. A presença da infecção foi equilibrada para a variável gênero: 1204 (12,56%) mulheres e 952 (13,92%) homens. Relacionando os graus da esofagite com HP+ e HP- observou-se que o tipo A foi o mais comum (58,79% da amostra, n=1460), que 604 (24,32%) possuíam o grau B; 334 (13,45%) o grau C e 85 (3,42%) o grau D. Já na relação entre os graus de esofagite com o gênero, a esofagite A foi predominante nas mulheres e presente em 929 (63,33%), seguido pelo tipo B, com 282 (46,68%), C com 136 (40,71%) e D com 30 (35,29%) mulheres. Nos homens 531 (36,36%) apresentam o tipo A, 322 (53,31%) o B, 198 (59,28%) o C e 55 (64,70%) o D. Entre os grupos de 40 a 50 anos e acima de 60 anos houve diferença significativa em ter ou não HP+. Conclusão: Não há diferença significativa entre infecção por HP nos diferentes graus de esofagite.

Análise da ocorrência sazonal de IAM em hospital universitário da cidade de Curitiba, Paraná / Analysis of seasonal occurrence of AMI in a university hospital in Curitiba, Paraná

O objetivo deste trabalho é demonstrar a relação entre sazonalidade e IAM através de pesquisa realizada no Hospital Universitário Evangélico de Curitiba (HUEC).Foram analisados 235 prontuários eletrônicos de pacientes que foram diagnosticados com IAM no ano de 2014 e internados no serviço de cardiologia do HUEC. Através da análise destes prontuários foram levantados: idade, sexo, motivo da procura pelo atendimento, período do dia, dia da semana, mês e estação do ano em que ocorreu o IAM. Foram encontrados que a faixa etária predominante é entre 60 e 69 anos (31%), 63% pertencentes ao sexo masculino, 56% dos pacientes deram entrada vindos de outros serviços de saúde já com o diagnóstico de IAM. A maioria dos pacientes foram atendidos no período da manhã, com destaque nas terças e sextas-feiras (19% cada), no mês de junho (17%) e no outono (32%). Assim, pode-se comprovar a relação entre IAM e sazonalidade e ocorrência semanal e circadiana em Curitiba.

The objective of this study is demonstrate the AMI seasonality relation in the University Hospital of Curitiba, PR. Which analyzed 235 electronic medical records of patients who were diagnosed with AMI in 2014 and admitted to the cardiology service of the Hospital Universitário Evangélico de Curitiba (HUEC). Through analysis of these records were collected data: reason for seeking care, sex and age of the patient, time of day, day of week, month and season it occurred AMI. We found that the predominant age group is between 60 and 69 years (31%), 63% were male and 56% of patients were coming entry of other health services already diagnosed with. As for the time of day, day of the week, month and season, most patients receiving healthcare in the morning, especially on Tuesdays and Fridays (19% each), in June (17%) and in the fall (32%). Therefore, it was confirmed the relationship between AMI and seasonality and weekly and Circadian occurrence.

Análise de fatores de risco em pacientes com diagnóstico de infarto agudo do miocárdio atendidos em hospital universitário da cidade de Curitiba, Paraná / Risk factors analysis in patients with diagnosis of acute myocardial infarction assisted at a university hospital in Curitiba, Paraná

O objetivo desse trabalho é demonstrar a presença dos fatores de risco para a ocorrência de infarto agudo do miocárdio (IAM) nos pacientes atendidos no Hospital Universitário de Curitiba, PR. Foram analisados: hipertensão arterial sistêmica, dislipidemia, diabetes mellitus, obesidade, sedentarismo, tabagismo, etilismo, IAM prévio, uso prévio de estatinas e uso prévio de anti-agregantes plaquetários. Como resultado foi demonstrado que 79% referiu HAS, 47% referiram dislipidemia, 36% eram portadores de DM, 60% dos informados obesos, 76% dos informados eram sedentários, 48% tabagista, 8% dos informados referiram etilismo, 43% já possuíam história prévia de IAM, 45% afirmaram uso contínuo prévio de estatinas e 63% anti-agregante plaquetário. Desta forma, evidencia-se que o controle dos fatores de risco cada vez mais destaca-se como importante alvo tanto de prevenção primária quanto secundária, devendo ser adotado como foco por parte das autoridades da saúde pública.

The objective of this study is to demonstrate the presence of risk factors for the occurrence of acute myocardialinfarction (AMI) in patients assisted at a university hospital of Curitiba, PR. We reanalyzed: hypertension, dyslipidemia, diabetes mellitus, obesity, sedentary lifestyle, smoking, alcohol consumption, previous AMI, previous use of statin drugs and previous use of antiplatelet agents. As a result it was demonstrated that 79% reported hypertension, 47% reported dyslipidemia, 36% had DM, 60% of obese informed, 76% of reported were sedentary, 48% smokers, 8% of reported reported alcohol use, 43% already had previous history of AMI, 45% said prior continuous use of statins and 63% antiplatelet. Thus, it is evident that the control of risk factors increasingly stands out as animportant target both primary and secondary prevention and should be adopted as a focus by the public health authorities.

Aneurisma dissecante de aorta em paciente com Síndrome de Marfan: um relato de caso / Dissecting aortic aneurysm in a patient with Marfan Syndrome: a case report

A Síndrome de Marfan é uma anomalia genética autossômica dominante do tecido conjuntivo com comprometimento sistêmico através do defeito da fibrilina-1. Entre as complicações clínicas destacam-se endocardite infecciosa, dissecção de aorta, insuficiência aórtica ou mitral, cardiomiopatia dilatada e descolamento de retina. O objetivo deste relato de caso foi descrever o caso de uma paciente do gênero feminino diagnosticada com Síndrome de Marfan que apresentava um extenso aneurisma de arco aórtico e aorta ascendente, submetida a tratamento cirúrgico bem sucedido no serviço de cardiologia do Hospital Vita Batel (Curitiba-PR). Assim, destaca-se a importância do diagnóstico precoce e terapêutica adequada.

Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue with multisystemic caused by defect of fibrillin-1. There are many clinical complications as infective endocarditis, aortic dissection, aorticor mitral insufficiency, dilated cardiomyopathy and retinal detachment. The purpose of this article is describe a female patient diagnosed withMarfan's syndrome and an extensive aneurysm of the aortic arch and ascending aorta who successful undergoing surgery in the cardiology service Vita Hospital Batel (Curitiba-Brasil).Thus, it highlights the importance of early diagnosis and appropriate therapy.