Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity.

BACKGROUND AND AIM: Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. METHODS AND RESULTS: We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 ± 11.52 ms × 89.38 ± 11.19 ms and 36.12 ± 3.46 mm × 31.45 ± 2.64 mm, (p < 0.0001). The mean LVEF was lower in the obese group: 63.15 ± 4.25% × 66.17 ± 3.37% (p < 0.017). The mean EFT was higher in the obese group: 7.72 ± 1.60 mm × 3.10 ± 0.85 mm (p < 0.0001). A positive correlation was found between EFT and PWD (r = 0.70; p = 0.001) and LAD (r = 0.667; p = 0.001). An inverse correlation was found between EFT and LVEF (r = -0.523; p = 0.001). In a multiple multivariate regression analysis the EFT remains correlated with LAD and LVEF. CONCLUSIONS: In a select group of morbidly obese, the excess of EF had a significant impact on atrial remodeling and cardiac function.

Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study.

OBJECTIVES: The main purpose of the study was to investigate left ventricular (LV) subclinical systolic and diastolic dysfunction in childhood-onset systemic lupus erythematosus (c-SLE) patients using two-dimensional speckle-tracking (2DST) echocardiography. We also interrogated possible correlations between impairment of myocardial deformation and the SLE Disease Activity Index 2000 (SLEDAI-2K), as well as the presence of traditional and disease-related cardiovascular risk factors (CRFs). METHOD: A total of 50 asymptomatic patients and 50 controls (age 14.74 vs. 14.82 years, p = 0.83) were evaluated by standard and 2DST echocardiography. RESULTS: Despite a normal ejection fraction (EF), there was reduction in all parameters of LV longitudinal and radial deformation in patients compared to controls: peak longitudinal systolic strain (PLSS) [-20.3 (-11 to -26) vs. -22 (-17.8 to -30.4)%, p < 0.0001], PLSS rate [-1.19 ± 0.21 vs. -1.3 ± 0.25 s(-1), p = 0.0005], longitudinal strain rate in early diastole [1.7 (0.99-2.95) vs. 2 (1.08-3.00) s(-1), p = 0.0034], peak radial systolic strain [33.09 ± 8.6 vs. 44.36 ± 8.72%, p < 0.0001], peak radial systolic strain rate [1.98 ± 0.53 vs. 2.49 ± 0.68 s(-1), p < 0.0001], and radial strain rate in early diastole [-2.31 ± 0.88 vs. -2.75 ± 0.97 s(-1), p = 0.02]. Peak circumferential systolic strain [-23.67 ± 3.46 vs. -24.6 ± 2.86%, p = 0.43] and circumferential strain in early diastole [0.37 ± 0.17 vs. 0.41 ± 0.15, p = 0.27] were similar between patients and controls, although peak circumferential systolic strain rate [-1.5 ± 0.3 vs. -1.6 ± 0.3 s(-1), p = 0.036] was reduced in c-SLE. Further analysis of patients revealed a negative correlation between LV PLSS and SLEDAI-2K (r = -0.52, p < 0.0001), and also between LV PLSS and the number of CRFs per patient (r = -0.32, p = 0.024). CONCLUSIONS: 2DST echocardiography has identified subclinical LV deformation impairment in c-SLE patients. Disease activity and cumulative exposure to CRFs contribute to myocardial compromise.

Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography.

OBJECTIVE: The objective of this article is to evaluate right ventricle strain imaging by two-dimensional speckle-tracking (2DST) in childhood-onset systemic lupus erythematosus (c-SLE). METHODS: Thirty-five c-SLE patients with no signs or symptoms of heart failure and 33 healthy volunteers were evaluated by standard echocardiogram and 2DST. Conventional parameters included tricuspid annular plane systolic excursion (TAPSE), RV tissue-Doppler-derived Tei index and systolic pulmonary artery pressure. Global peak longitudinal systolic strain (PLSS) and strain rate (PLSSR) of RV were obtained by 2DST. Demographic/clinical features, SLEDAI-2K/SLICC/ACR-DI and treatment were also assessed. RESULTS: The median current age was similar in patients and controls (14.75 vs. 14.88 years, p = 0.62). RV PLSS was significantly reduced in c-SLE (-24.5 ± 5.09 vs. -27.62 ± 3.02%, p = 0.003). Similar findings were observed after excluding patients with pulmonary hypertension (-24.62 ± 4.87% vs. -27.62 ± 3.02%, p = 0.0041). RV PLSS was positively correlated with TAPSE (r = +0.49, p = 0.0027) and negatively correlated with Tei index (r = -0.34, p = 0.04) in c-SLE. RV PLSSR was not different comparing patients and controls (-0.65 s(-1 )± 0.47 vs. -1.87 ± 0.49 s(-1), p = 0.07). Further analysis of c-SLE patients revealed higher frequencies of neuropsychiatric manifestations (39% vs. 0%, p = 0.007) and antiphospholipid antibodies (55% vs. 18%, p = 0.035) in those with RV PLSS ≤ -23.7% vs >-23.7%. No differences were evidenced in demographic data, disease activity/damage or treatments (p > 0.05). CONCLUSIONS: The present study, using a new and more sensitive technique, revealed subclinical RV systolic dysfunction in c-SLE patients that may have future prognostic implications. The novel association of asymptomatic RV dysfunction with neuropsychiatric manifestations and antiphospholipid antibodies may suggest common physiopathological pathways.

Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes.

We evaluated the effects of recreational football training combined with calorie-restricted diet (football + diet) vs calorie-restricted diet alone (diet) on aerobic fitness, lipid profile, and insulin resistance indicators in type 2 diabetes (T2D) patients. Forty-four T2D patients aged 48-68 years (27 females, 17 males) were randomly allocated to the football + diet group (FDG; n = 22) or to the diet group (DG; n = 22), of whom 19 FDG and 15 DG subjects completed the study. The football training was performed for 3 × 40 min/week for 12 weeks. Dual-energy X-ray absorptiometry scanning, treadmill testing, and fasting blood samplings were performed pre and post-intervention. After 12 weeks, maximal oxygen uptake (VO2max ) was elevated (P < 0.05) by 10 ± 4% in FDG but not in DG (-3 ± 4%, P < 0.05). After 12 weeks, reductions in blood triglycerides (0.4 ± 0.1 mmol/L), total cholesterol (0.6 ± 0.2 mmol/L), low-density lipoprotein, and very low-density lipoprotein levels were observed only in FDG. Fat mass decreased (P < 0.05) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG. The lower (P < 0.05) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG. In conclusion, football combined with restricted diet was effective in enhancing VO2max , reducing total cholesterol and triglycerides, and increasing insulin sensitivity, potentially providing better tools for the prevention of T2D complications than diet alone.

[Treatment of severe spinal deformity with 3D printing models]. / Tratamiento de deformidad severa de la columna vertebral con modelos de impresión 3D.

INTRODUCTION: Scoliosis is a complex deformity that affects all three planes of the axis of the spine. The association between neuromuscular pathology and vertebral alignment was initially described in 1960. Neuromuscular pathology is progressive and results in postural abnormalities. Surgical goals in patients with neuromuscular deformity include anatomical correction for sedation and ambulation, as well as functional improvement. The gold standard of treatment is by posterior approach with transpedicular screws. The "hands-free" technique saves surgical time, decreases radiation by reducing the use of fluoroscopy. The advent of 3D printing technology allows precise study of the anatomical area and detail of the deformity in its three planes. This model can be sterilized for transoperative guidance. A 13-year-old female patient who develops thoracolumbar neuromuscular scoliosis secondary to spastic cerebral palsy (CP), with previous instrumentation T11-L3 of which he develops severe proximal curve. After the segmentation of the three-dimensional model, pedicle violation greater than 2 mm towards bilateral medullary canal was detected in the pedicles of L1 and L2 of previous instrumentation, pedicle dysplasia and the morphological characteristics of the pedicles were observed. Three-dimensional planning and the use of surgical guides represent a tool for surgical planning, especially in severe cases and with pedicle dysplasia. It helps as a surgical guide for the placement of hands-free transpedicular screws with possible reduction of radiation and anesthetic time.

INTRODUCCIÓN: La escoliosis es una deformidad compleja que afecta los tres planos del eje de la columna vertebral. La asociación entre patología neuromuscular y la alineación vertebral fue descrita inicialmente en 1960. La patología neuromuscular es progresiva y resulta en anormalidades posturales. Las metas quirúrgicas en pacientes con deformidad neuromuscular engloban la corrección anatómica para la sedestación y deambulación, así como mejoría funcional. El estándar de oro de tratamiento es por vía posterior con tornillos transpediculares. La técnica de "manos libres" ahorra tiempo quirúrgico, disminuye la radiación al reducir el uso de fluoroscopía. El advenimiento de la tecnología de impresión 3D permite estudio preciso del área anatómica y detalle de la deformidad en sus tres planos. Este modelo puede ser esterilizado para guía transoperatoria. Paciente femenino de 13 años de edad que desarrolla escoliosis neuromuscular toracolumbar secundario a parálisis cerebral infantil (PCI) espástica, con instrumentación previa T11-L3 de la cual desarrolla curva severa proximal. Finalizada la segmentación del modelo tridimensional se detectó violación pedicular mayor a 2 mm hacia canal medular bilateral en los pedículos de L1 y L2 de instrumentación previa, displasia pedicular y se observaron las características morfológicas de los pedículos. La planeación tridimensional y el uso de guías quirúrgicas representan una herramienta para la planeación quirúrgica, sobre todo en casos severos y con displasia pedicular. Ayuda como guía quirúrgica para la colocación de tornillos transpediculares a manos libres con posible reducción de radiación y tiempo anestésico.

[Biomechanical analysis of interespinous ligamentoplasty with polyester fiber after discectomy]. / Análisis biomecánico de la ligamentoplastía interespinosa con fibra de poliéster posterior a discectomía.

INTRODUCTION: There are different pathologies of the lumbar spine that condition a biomechanical and clinical instability for its treatment, various stabilization techniques have been carried out that try to preserve the movement and the transmission of load of the affected segment such as the interspinatus ligamentplasty with Dallos® fiber. OBJECTIVE: To show the biomechanical variations of functional segment of lumbar spine of pigs, before and after performing the discectomy and ligamentoplasty with Dallos® fiber. MATERIAL AND METHODS: The lumbar segment was mounted in a servo-hydraulic multiaxial simulator. Mobility ranges of flexion, extension, lateral flexion and axial rotations were simulated under three conditions: 1. Natural segment, 2. Discectomy segment, and 3. Disectomized segment plus ligamentoplasty with Dallos® fiber. The mobility ranges are made up to a torque of 7.5 N-m The data of the torques and mobility ranges was collected in the simulator program and the results of the biomechanical changes between the three conditions described were plotted. RESULTS: It was shown that lumbar biomechanics is affected after discectomy mainly in flexion and extension. In the left axial bending and rotation movements, an alteration of torque and mobility ranges was found. CONCLUSIONS: The ligamentoplasty recovers part of the stability lost after discectomy preserving part of the disc height without reaching to equalize the movements as in the natural segment. After discectomy the distribution of force suggests that residual instability with ligament plasty may represent facet overload.

INTRODUCCIÓN: Existen diferentes patologías de la columna lumbar que condicionan una inestabilidad biomecánica y clínica para su tratamiento, se han efectuado diversas técnicas de estabilización que tratan de preservar el movimiento y la transmisión de carga del segmento afecto como la ligamentoplastía interespinosa con fibra Dallos®. OBJETIVO: Mostrar las variaciones biomecánicas de segmento funcional de columna lumbar de porcino, antes y después de realizar la discetomía y ligamentoplastía con fibra Dallos®. MATERIAL Y MÉTODOS: El segmento lumbar se montó en un simulador multiaxial servo-hidráulico. Se simularon rangos de movilidad de flexión, extensión, flexiones laterales y rotaciones axiales en tres condiciones: 1) segmento natural; 2) segmento discectomizado; y 3) segmento disectomizado más ligamentoplastía con fibra Dallos®. Los rangos de movilidad se realizan hasta un torque de 7.5 N-m. La data de los torques y rangos de movilidad se recolectó en el programa del simulador y se graficaron los resultados de los cambios biomecánicos entre las tres condiciones descritas. RESULTADOS: Se demostró que la biomecánica lumbar es afectada después de la discectomía principalmente en la flexión y la extensión. En los movimientos de flexión y rotación axial izquierdas, se comprobó una alteración del torque y los rangos de movilidad. CONCLUSIONES: La ligamentoplastía recupera parte de la estabilidad perdida postdiscectomía, preservando parte de la altura discal sin llegar a igualar los movimientos como en el segmento natural. Posterior a la discectomía, la distribución de la fuerza sugiere que la inestabilidad residual con ligamento plastía puede representar sobrecarga facetaria.

Classification of the site of ventricular septal defect by 2-dimensional echocardiography.

Sixty-three consecutive patients aged 2 months to 27 years with simple ventricular septal defect (VSD) or the syndrome of Fallot's tetralogy were prospectively investigated with 2-dimensional (2-D) echocardiography to assess the accuracy of the method in defining the anatomic site of the VSD. Twenty-two patients were referred for surgery without invasive investigation. The anatomy was confirmed in all patients at operation. Two-dimensional echocardiography was reliable in identifying subaortic, inlet, small, moderate, and large subtricuspid, large subpulmonary, and most large central and apical muscular VSDs. Mistakes were made initially in distinguishing doubly committed subarterial defects from subaortic VSD because of difficulty in imaging the right ventricular outflow in short axis at the aortic root level, small subpulmonary defects obscured by prolapsed aortic cusp tissue, and small apical or outlet muscular VSDs because of difficulty in distinguishing true "dropout" from trabeculations. Other VSDs particularly muscular, were sometimes overlooked after another large VSD had been identified. Thus, identification of the anatomic site of VSDs by 2-D echocardiography is a reliable method that can replace invasive investigation in assessing the uncomplicated VSD before operation. Ventricular septal defects are classified as muscular or subvalvular and subdivided according to the valve to which the defect is related.

Two-dimensional echocardiographic assessment of surgically closed ventricular septal defect.

One hundred twenty patients operated on for closure of a ventricular septal defect (VSD) had postoperative assessment by 2-dimensional echocardiography. The presence of persistent "drop-out" between ventricular septum (VS) and the periphery of the "patch" was considered a sign of detachment and residual shunt. Echocardiographic findings of intact VS or residual VSD were correlated with angiographic findings in 30 patients and with clinical signs in 90 patients. Minute shunts with increased flow ratios less than 1.5:1 were occasionally missed. Persistent small drop-out was sometimes wrongly diagnosed as residual shunt when the patch was in an angled position and in the early postoperative weeks when peripatch edema of the VS suggested drop-out. Thus, 2-dimensional echocardiography is a reliable method for assessing significant persistent ventricular shunts and intact VS after surgical closure of a VSD.

Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4,033 consecutive studies.

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4,033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 microg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1,280 studies. There were 3,645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction, and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

Importance of intraoperative transesophageal echocardiography during coronary artery surgery without cardiopulmonary bypass.

The goal of this study was to assess left ventricular segmental wall motion (SWM) abnormalities during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), and its impact on the immediate postoperative outcome. Transesophageal echocardiography was used intraoperatively in 27 patients (mean age 57 years) who had CABG without CPB. Images obtained with a 5-MHz biplane transesophageal echocardiographic probe in the transgastric and transesophageal planes were recorded before, during, and after 48 coronary artery clampings for saphenous vein or internal mammary artery anastomosis. Transthoracic echocardiography was performed 1 day before surgery and on the seventh postoperative day. During the 48 coronary artery clampings, 31 (64%) new SWM abnormalities were found. At the time of chest closure, complete recovery occurred in 16 (50%) segments, partial recovery in 10 (33%), and no recovery in 5 (17%). On the seventh postoperative day the new SWM abnormalities persisted in all 5 segments without recovery at the end of the surgery and in 2 of 10 (20%)segments with partial recovery (group 1). Group 1 had higher variation on the echocardiographic point score index between the beginning and end of surgery, higher enzymatic levels, more ST-T changes on the electrocardiogram, and more clinical problems than group 2 (patients without new SWM abnormalities on the seventh postoperative day) (P < .05). We concluded that new SWM abnormalities of the left ventricle occur during CABG without CPB as assessed by intraoperative transesophageal echocardiography. Persistence of these abnormalities at the end of surgery may be a predictor of SWM dysfunction and clinical problems in the immediate postoperative period.

Urinary excretion of digoxin-like immunoreactive factor and arginine-vasopressin in rats after several osmotic loads.

Urinary digoxin-like immunoreactive factor (DLIF), arginine-vasopressin (AVP) and other urinary parameters were investigated under normal conditions and after the i.p. injection of the following solutions: distilled water, isotonic and hypertonic NaCl, NaHCO3, KCl and urea, at a rate of 3 ml/100 g body weight. The measurement of digoxin-like immunoreactivity by two different radioimmunoassays showed that DLIF was stimulated by all volume loads regardless of the presence or absence of osmolar compounds. This dissociation between DLIF and urinary sodium excretion suggests that DLIF may not constitute the natriuretic hormone. Moreover, a dissociation between DLIF and AVP excretion also were found, which speaks against the hypothesis of a common mechanism of stimulation for both substances.

Aortic and mitral discontinuity with congenital subaortic aneurysm and normally connected great arteries: echocardiographic diagnosis in life.

A newborn with preductal coarctation and ventricular septal defect had a subaortic aneurysm which protruded into the left atrium causing intractable pulmonary oedema. The subaortic aneurysm was congenital. It was clearly identified by cross-sectional echocardiography which, in serial studies, showed it to be increasing in size. Predisposing to its development was the wide area of aortic and mitral discontinuity in association with the concordant ventricular connexion of the great arteries. The child remained in worsening pulmonary oedema after relief of the coarctation and banding of the pulmonary trunk and died after attempted relief of the left atrial obstruction.

Physiologic multivalvular regurgitation during pregnancy: a longitudinal Doppler echocardiographic study.

Valvular function, assessed by Doppler technique, has not been extensively investigated during normal pregnancy. To prospectively study this feature, 18 normal pregnant women were followed during their pregnancies and puerperium, with serial clinical and pulsed-continuous Doppler echocardiographic examinations. In four gestational periods and the puerperium, we analysed: (a) ventricular and atrial dimensions, as well as valve annular diameters; (b) prevalence and characteristics of trivial valvular regurgitations. During pregnancy, slight but significant increases of the four cardiac chamber dimensions and valve annular diameters were observed, except for the aortic ring. The prevalence of physiologic valvular regurgitation in early pregnancy (mitral, 0%; tricuspid, 38.9%; pulmonary, 22.2%; aortic, 0%), was similar to a control group of 18 healthy non-pregnant women. As pregnancy evolved, there was a progressive and significant increase of multivalvular regurgitation, maximal at full-term (mitral, 27.8%; tricuspid, 94.4%; pulmonary, 94.4%, P < 0.05 vs. early pregnancy). Aortic regurgitation was not detected in any stage of pregnancy. In the puerperium, mitral regurgitation resolved, but tricuspid and pulmonary regurgitation were still significantly prevalent (83.3% and 66.7%, respectively, P < 0.05 vs. early pregnancy). It is concluded that physiologic multivalvular regurgitation is frequent in pregnancy, mainly involving right-sided valves in late gestational periods, occasionally persisting in the early puerperium. Chamber enlargement, valve annular dilatation, and increased prevalence of trivial valve regurgitation are time-related events during normal pregnancy, resulting from a reversible cardiac remodeling process induced by physiologic volume overload. These aspects should be considered for a correct interpretation of Doppler echocardiographic findings in pregnant women with suspected heart disease.

Cardiopulmonary exercise testing early after catheter-balloon mitral valvuloplasty in patients with mitral stenosis.

Seven female patients (age 27 to 53 yr) with significant mitral stenosis performed continuous, incremental, maximal treadmill exercise tests the day before and within 3-5 days after catheter-balloon valvuloplasty. Mitral valve area determined by the echo-Doppler method increased from 0.9 +/- 0.3 cm2 to 1.9 +/- 0.7 cm2 (p < 0.02). Mean left atrial pressure was reduced from 24 +/- 8 to 13 +/- 7 mmHg (p < 0.01) and mean pulmonary artery pressure from 36 +/- 13 to 28 +/- 10 mmHg (p < 0.02) with a non-significant increase in cardiac output from 3.6 +/- 1.2 to 4.0 +/- 1.7 l/min. After catheter-balloon valvuloplasty all patients reached a higher maximal workload during exercise, and mean value of oxygen consumption and pulmonary ventilation were significantly lower in submaximal workloads. The calculated ventilatory equivalent for oxygen was significantly reduced in submaximal and in maximal workloads after catheter-balloon valvuloplasty. Peak oxygen consumption and the ventilatory anaerobic threshold were not changed after catheter-balloon valvuloplasty (pre 15.59 +/- 2.72 vs post 16.90 +/- 3.44 and pre 12.10 +/- 2.55 vs post 12.62 +/- 2.71 ml/kg/min, respectively). We concluded that after catheter-balloon valvuloplasty the cost of breathing was reduced and the oxygen consumed was more effectively utilized during exercise. Increases in peak oxygen consumption and in ventilatory anaerobic threshold would require circulatory and metabolic adaptations in response to increased physical activity and were not observed when cardiopulmonary tests were performed early after catheter-balloon valvuloplasty.

Maintenance of midgut epithelial cells from Dendroctonus valens (Coleoptera: Scolytidae) in vitro.

This article describes the culture of epithelial cells from anterior and posterior midgut regions of adult Dendroctonus valens. Culture conditions were established, and cell adherence was improved by means of a new technique that allowed the cells to grow between two glass coverslips. Cytoplasmic projections occur as anterior midgut cells grow to confluence; these projections were not observed in cells of the posterior midgut. The optimal culture medium for the maintenance of these epithelial cells was Roswell Park Memorial Institute 1640 medium at 25 degrees C. Cells in Grace's medium died in 24 h. Cultures did not require CO(2) atmosphere, but culture development was favored by the microaerophilic environment and the dark conditions in which the cells were grown, between the coverslips.

Regulation of water flux through tropical forest canopy trees: do universal rules apply?

Tropical moist forests are notable for their richness in tree species. The presence of such a diverse tree flora presents potential problems for scaling up estimates of water use from individual trees to entire stands and for drawing generalizations about physiological regulation of water use in tropical trees. We measured sapwood area or sap flow, or both, in 27 co-occurring canopy species in a Panamanian forest to determine the extent to which relationships between tree size, sapwood area and sap flow were species-specific, or whether they were constrained by universal functional relationships between tree size, conducting xylem area, and water use. For the 24 species in which active xylem area was estimated over a range of size classes, diameter at breast height (DBH) accounted for 98% of the variation in sapwood area and 67% of the variation in sapwood depth when data for all species were combined. The DBH alone also accounted for > or = 90% of the variation in both maximum and total daily sap flux density in the outermost 2 cm of sapwood for all species taken together. Maximum sap flux density measured near the base of the tree occurred at about 1,400 h in the largest trees and 1,130 h in the smallest trees studied, and DBH accounted for 93% of the variation in the time of day at which maximum sap flow occurred. The shared relationship between tree size and time of maximum sap flow at the base of the tree suggests that a common relationship between diurnal stem water storage capacity and tree size existed. These results are consistent with a recent hypothesis that allometric scaling of plant vascular systems, and therefore water use, is universal.

Evaluation of stunned and infarcted canine myocardium by real time myocardial contrast echocardiography.

Differentiation between stunned and infarcted myocardium in the setting of acute ischemia is challenging. Real time myocardial contrast echocardiography allows the simultaneous assessment of myocardial perfusion and function. In the present study we evaluated infarcted and stunned myocardium in an experimental model using real time myocardial contrast echocardiography. Sixteen dogs underwent 180 min of coronary occlusion followed by reperfusion (infarct model) and seven other dogs were submitted to 20 min of coronary occlusion followed by reperfusion (stunned model). Wall motion abnormality and perfusional myocardial defect areas were measured by planimetry. Risk and infarct areas were determined by tissue staining. In the infarct model, the wall motion abnormality area during coronary occlusion (5.52 1.14 cm(2) ) was larger than the perfusional myocardial defect area (3.71 1.45 cm (2); P < 0.001). Reperfusion resulted in maintenance of wall motion abnormality (5.45 1.41 cm (2); P = 0.43 versus occlusion) and reduction of perfusional myocardial defect (1.51 1.29 cm (2); P = 0.004 versus occlusion). Infarct size determined by contrast echocardiography correlated with tissue staining (r = 0.71; P = 0.002). In the stunned model, the wall motion abnormality area was 5.49 0.68 cm (2) during occlusion and remained 5.1 0.63 cm (2) after reperfusion (P = 0.07). Perfusional defect area was 2.43 0.79 cm (2) during occlusion and was reduced to 0.2 0.53 cm(2) after reperfusion (P = 0.04). 2,3,5-Triphenyl tetrazolium chloride staining confirmed the absence of necrotic myocardium in all dogs in the stunned model. Real time myocardial contrast echocardiography is a noninvasive technique capable of distinguishing between stunned and infarcted myocardium after acute ischemia.

Prevalence of lower limb occlusive vascular disease in outclinic diabetic patients.

AIM: The aim of this study was to determine the prevalence and risk factors for peripheral occlusive vascular disease (POVD) in subjects with diabetes mellitus (DM) in Brazil. METHODS: We evaluated 236 diabetic individuals, in spontaneous demand, representing 471 legs. POVD was assessed by the ankle brachial index (ABI). RESULTS: The mean age was 62.1 years (range 22-89 years), 52% were male, 93.2% type II DM and the mean time to diagnosis was 7.9 years (range 0-37 years). Sixty percent were hypertensives. In 61% at least one pulse was diminished or absent. The prevalence of ischemia was 18% (ABI<0.9) while 22% had an ABI compatible with high grade arterial calcification (ABI>1.3). Overall less than 1/3 of the cases had the vascular exam that could be considered normal. The ABI was lower in subjects with pulse deficit (p<0.001), and a normal pulse had a negative predictive value for ischemia of more than 90%. Subjects with normal pulses were younger and had a decreased diabetes duration (p<0.001 and p<0.05, respectively). An increase in the duration of the diabetes was associated with a progressive decrease in the ABI (p<0.01). Female gender and hypertension were associated with a reduced ABI (p<0.01 and p<0.05, respectively). CONCLUSION: There is a high prevalence of POVD in diabetic individuals. The disease is associated with hypertension and female gender and gets worse with increasing duration of the diabetes.

Echocardiographic routine analysis of the coronary sinus by an apical view: normal and abnormal features.

The echocardiographic aspects of the coronary sinus have not received much attention in the literature. In the few published articles about anomalous venous connection to the coronary sinus, the parasternal long axis view has been suggested as ideal for its visualization. More recently, it has been suggested that the coronary sinus in normal hearts is best visualized from the apical transducer position. The purpose of this study was to assess the appearance of the coronary sinus from an apical view in a group of 400 consecutive patients with ages varying from 5 days to 80 years. In ten patients with persistent left superior vena cava, the coronary sinus was markedly dilated throughout its extension. All cases were confirmed either by angiography or surgery. In another three patients with Ebstein's anomaly studied postoperatively, it was observed that the coronary sinus was abnormally draining into the right ventricle below the prosthesis plane. These findings were confirmed by the surgical reports. The routine evaluation of the coronary sinus was better performed by an apical view, which provided detailed information not only of normal, but also abnormal anatomy of this segment of the heart. We speculate that it could be especially useful in diagnosing coronary sinus atresia and thrombosis, and coronary ostium atresia, as well as total anomalous intracardiac pulmonary venous drainage.

[Assessment of pulmonary arterial pressure in adults with Doppler echocardiography]. / Avaliação da pressão arterial pulmonar em adultos pela Eco-Dopplercardiografia.

PURPOSE: To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS: Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS: An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p < 0.05) in patients with severe PH (mean PAP > or = 40 mmHg), comparing with patients with PAP < 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p < 0.05) excluding patients with atrial fibrillation (19 cases). CONCLUSION: PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.