Characterization of bergamot essential oil: chemical, microbiological and colloidal aspects.

Citrus bergamia is a citric species known as bergamot. The species is widely used due to its derivatives, such as juices, extracts, and essential oil. Specifically, the bergamot essential oil (BEO) is of great interest, with a chemical composition rich in terpenes and esters. Considering its chemical composition, bioactivity, and great economic potential, the characterization of BEO should be studied. However, this essential oil is almost unexplored in terms of a characterization associated with colloids. Chemical characterization was carried out by gas-chromatography coupled to a mass spectrometer and by gas-chromatography coupled to a flame ionization detector. Antibacterial activity against Staphylococcus aureus and Escherichia coli was carried out to confirm the bioactivity of this important essential oil. Dynamic light scattering analysis was performed to create a pattern of droplet size distribution of BEO. Major compounds of BEO were linalyl acetate, limonene, and linalool. The BEO was active against E. coli and presented a MIC value of 2.000 µg/mL, while values of MIC and MBC higher than 2.000 µg/mL were observed for S. aureus. The dynamic light scattering analysis revealed a mean hydrodynamic diameter of 65.7 ± 2.2 nm. After a 1:10 dilution it was observed reduction of mean diameter and enhancement of the percentagem of low size droplets, resepctively 44.1 ± 1.2 nm and 14.5 ± 0.5 nm (28.8 ± 1.2%). Higher droplets and reduced polydispersity index were observed after 1:100 dilution. In the present study, the chemical characterization was in accordance with the species, as the characteristic chemical markers of the species were found. Moreover, it has presented antibacterial activity as expected for the BEO. The analysis of the colloid showed a pattern of droplet size distribution following the Ostwald ripening mechanism after dilution.

Clinical influence of calcium hydroxide and N-acetylcysteine on the levels of resolvins E1 and D2 in apical periodontitis.

AIM: To investigate the presence of resolvins E1 (RvE1) and D2 (RvD2) in teeth with primary endodontic infections and apical periodontitis, and to assess the influence of calcium hydroxide medication [Ca(OH)2 ], in association with 2% chlorhexidine gel (2% CHX gel), and N-acetylcysteine (NAC) on the levels of RvE1 and RvD2 in periapical tissues. METHODOLOGY: Thirty-six single-rooted teeth with primary endodontic infections and apical periodontitis were selected and randomly divided into three groups according to the medication: [Ca(OH)2 ] + saline solution (SSL) [Ca(OH)2  + SSL group] (n = 12), Ca(OH)2  + 2% chlorhexidine gel [Ca(OH)2  + 2% CHX gel group] (n = 12) and NAC [NAC group] (n = 12). Samples were collected from the periapical interstitial fluid at two different sampling times: before (S1) and after 14 days of intracanal medications (S2). Resolvins were measured using the enzyme-linked immunosorbent assay. Data were analysed using paired t-test, Wilcoxon test and Kruskal-Wallis test, followed by Dunn's post hoc test; all statistical tests were performed at a significance level of 5%. RESULTS: RvE1 and RvD2 were detected in 100% of the samples (36/36) at S1 and S2. Ca(OH)2 medication did not increase the levels of RvE1 or RvD2 (both P > 0.05); however, NAC significantly increased the levels of RvE1 and RvD2 after 14 days of treatment (P < 0.05). CONCLUSIONS: RvE1 and RvD2 were detected in periapical tissues from teeth with root canal infections. Moreover, calcium hydroxide medication did not increase the levels of resolvins in apical periodontitis. In contrast, the use of NAC intracanal medication significantly increased the levels of RvE1 and RvD2 after 14 days of treatment.

[The angioplasty of chronic coronary occlusions with the excimer laser for debulking followed by stent implantation]. / Angioplastia de oclusões coronárias crónicas com laser excimer para debulking seguido de implantação de stent.

UNLABELLED: Coronary angioplasty (PCI) of chronic total occlusions (CTO), even when successful, are associated to less favourable long term results. The recent use of coronary stents has improved the long term outcome of those interventions. PURPOSE: To evaluate the short term results and long term occurrence of major adverse coronary events (MACE): death, MI, urgent revascularization and the need for a new target vessel revascularization (TVR) in patients with CTO who had previously been submitted to a PCI with excimer laser for plaque debulking followed by a provisional stent. POPULATION: From our database, we selected 19 patients with a mean age of 51 +/- 13 years (18 male) submitted to PCI between 1994 and 1998. Of those patients, 10 had had of a previous MI. Hypertension, smoking habits and hypercholesterolemia were present in 9 patients (42%). Two patients had diabetes. The main reason for PCI was stable angina in 16 patients (84%) and unstable in 3 patients (16%). Single-vessel disease was present in 18 patients (94%) and multiple-vessel in 1 patient (6%); left ventricular ejection fraction was preserved in 18 patients (94%). Single vessel PCI was performed in 16 patients (84%) and double vessel in 3 patients. Plaque debulking with excimer laser was performed in all patients, followed by 23 stents (Multilink--8; Gianturco Roubin--5; Palmaz Schatz--4; others--6). The mean clinical follow-up was 19 months. RESULTS: There were no major short-term clinical events (death, MI or urgent revascularization). During follow-up, TVR was only required in 5 patients (26%), all of them in the first 7 months after PCI. CONCLUSIONS: In the highly selected population, PCI for chronic total occlusion, with excimer laser plaque debulking followed by provisional stents, was a safe procedure with a very acceptable rate of new target vessel revascularization in the follow-up period.

[Peripheral revascularization by cardiologists]. / Revascularização periférica por cardiologistas.

OBJECTIVE: To analyse the initial experience in peripheral arterial revascularization, using percutaneous techniques, by interventional cardiologists. DESIGN: Retrospective clinical study. SETTING: Cardiology department of a specialised public non-university hospital. PATIENTS: Twenty patients, 18 male and 2 female, with ages between 37 and 84 years, who underwent peripheral interventions between May 5 1989 and February 20 1998. INTERVENTIONS: Patients were subdivided into two groups: Group I, 9 patients, 8 male, average age of 56 +/- 13 years, undergoing renal artery angioplasty; Group II, 11 patients, 10 male, average age of 63 +/- 10 years, undergoing angioplasty of the distal aorta (1), of the right subclavian artery (1), of the iliac arteries (6) and of the femoral arteries (3). In Group I, 11 arteries were dilated, 6 by balloon angioplasty and 5 with stent implantation (Palmaz-Schatz--4 and Symphony--1). In Group II, 12 arteries were dilated, 5 by balloon angioplasty and 7 with 12 stent implantations (Palmaz-Schatz--6, Symphony--5 and NIRTM--1). In 8 patients, 1 of Group I and 7 of Group II, coronary angioplasty was also performed in 14 arteries and 18 segments, exclusively by balloon (3 patients) or with 10 stent implantations (5 patients). RESULTS: There was angiographic success in all patients (100%) and clinical success in 85% (17/20) of patients. All clinical complications occurred in Group I patients: retroperitoneal bleeding in one; right femoral artery pseudoaneurysm requiring surgery in one patient: acute renal failure in one patient. There were no cardiac complications in patients undergoing peripheral and cardiac angioplasties at the same stage. In the mean follow-up period of 26 months, one patient required reangioplasty of a right iliac artery and another underwent iliac-femoral bypass, both of Group II and before peripheral stents were available. CONCLUSIONS: Percutaneous peripheral arterial revascularization performed by experienced interventional cardiologists seems safe and efficient, being perfectly justified in patients requiring simultaneous coronary angioplasty.

[Revascularization in patients with prior coronary bypass surgery]. / Revascularização em pacientes com cirurgia prévia de bypass coronário.

UNLABELLED: Increasingly over the past several years, patients have returned after coronary surgery for reintervention procedures. This reflects immediate postsurgical complications and the relentless progression of coronary artery disease in the native circulation and in the bypass grafts. Although there are randomized comparative data for coronary bypass surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) and medical therapy, these trials have always excluded patients with previous (GABG). OBJECTIVES: We attempted to compare the risks and benefits of percutaneous transluminal coronary angioplasty (PTCA) and repeat coronary artery bypass grafting (re-CABG) in patients with previous coronary bypass surgery (CABG). METHODS AND RESULTS: This study examines follow up data (15.4 +/- 11.0 months) from 130 patients with previous CABG, who required either PTCA (Group A, n = 73) or re-CABG (Group B; n = 57) at a single center from 1994 to 1997. Follow up data were obtained from subsequent office visits and telephone calls. The PTCA and re-CABG groups were similar with respect to gender (86% vs 94% males), mean age (62 +/- 9 vs 59 +/- 10 years), angina CCS classes 3 and 4 (73% vs 69%), diminished left ventricular function (23% vs 26%), risk factors such as diabetes (19% vs 17%), hypercolesterolemia (49% vs 45%) and smoking (48% vs 39%) and three-vessel native coronary artery disease (67% vs 72%). The symptomatic status prior to the revascularization procedure was similar in both groups. Complete and functional revascularization was achieved in 85% of the PTCA group and in 92% of those with re-CABG (p = NS). During the hospital stay the complication rates were lower in the PTCA group. Actuarial survival was different at follow up (p = 0.04). Both PTCA and re-CABG groups resulted in equivalent event-free survival (freedom from death, myocardial infarction, unstable angina and urgent revascularization). The need for repeat revascularization at follow up was significantly higher in the PTCA group (PTCA 28% vs re-CABG 10%, p < 0.01). CONCLUSIONS: In this non-randomized study of patients with previous CABG requiring revascularization procedures, PTCA resulted in lower procedural morbidity and mortality risks. At follow up, both PTCA or CABG were similar for event-free survival; PTCA offered lower overall mortality, although it is associated to a greater need for subsequent revascularization procedures.

[The radiofrequency catheter ablation of ventricular tachycardia]. / Ablação por cateter de taquicardia ventricular com energia de radiofrequência.

OBJECTIVE: The aim of this study was to evaluate our results of radiofrequency catheter ablation (RFCA) of ventricular tachycardia. PATIENT SELECTION: We treated with RFCA nine patients, six male and three female, mean age 36 +/- 12 years with ventricular tachycardia (VT), who fulfilled the following criteria; 1) recurrent VT; 2) resistant fo medical therapy despite the use of more than one antiarrhythmic drug; 3) inducible by programmed ventricular stimulation; 4) hemodynamically well tolerated. The VT etiology was coronary artery disease (CAD) in three patients, dilated cardiomyopathy in one, right ventricular dysplasia in one and it was idiopathic in four (being fascicular in three and catecholaminergic right ventricular outflow tract VT in one). METHODS: The RFCA was performed under antiarrhythmic medication. The adequate ablation site was obtained by mapping of the VT, looking for the earliest ventricular activation, identification of isolated mid-diastolic potentials during sinus rhythm or presystolic during VT, good pace mapping (at least 10 of the 12 standard ECG leads), and high frequency short duration spikes, the so called P potentials in fascicular VT. Primary success achieved when occurred termination of VT during application of RF energy and/or VT was no longer inducible by programmed stimulation with the same stimulation protocol. RESULTS: Global primary success rate was 89%, being 100% in idiopathic VT, and 80% in VT associated with structural heart disease. In a follow-up period of 12 +/- 14 months all patients were alive, 75% free of VT in the idiopathic VT group; and 50% in patients with structural heart disease. One of these patients underwent cardioverter defibrillator implantation to treat a fast VT with a new morphology not treated by ablation, and the other two had VT modification with a significant reduction in the number of episodes. CONCLUSIONS: Radiofrequency catheter ablation of VT has shown a good success rate, and it is a valuable alternative in patients with hemodynamically tolerable VT, refractory to drug treatment, highly symptomatic and without surgical indication. In cases of idiopathic VT we had a high rate success and we think that RFCA will probably become the primary indication in symptomatic patients.

[Occlusion of the common branch of the left coronary artery. Clinical and angiographic characteristics and review of the literature]. / Oclusão do tronco comum da coronária esquerda. Aspectos clínicos, angiográficos e revisão da literatura.

The clinical and angiographic aspects of seven patients with left main stem coronary artery occlusion diagnosed within the first ten thousand coronary angiographies performed at our Hospital, are reported. The prevalence found (0.07%), is similar to that previously described (0.03 to 0.42%). Left main coronary artery occlusion is always an acute phenomenon with potentially very severe consequences. The existence of previously well developed collateral circulation from the right coronary artery, may avoid the occurrence of extensive acute myocardial infarction with cardiogenic shock and death, which otherwise follows the acute occlusion. Once diagnosed, coronary artery bypass surgery is the first choice treatment, although coronary angioplasty can be performed as a bridge for surgery, or as an alternative, if surgery is not available or is not recommended, int he acute setting of myocardial infarction. Three of our patients underwent successful angioplasty, one electively and two as an emergency during acute myocardial infarction with cardiogenic shock, and five had coronary surgery, one after previous angioplasty due to restenosis. There are only three long term survivors. In our small experience, the severe hemodynamic deterioration after left main occlusion is the major risk factor for mortality, which can only be avoided by early angiographic diagnosis.

[The catheter ablation of tachyarrhythmias. The experience of the Hospital de Santa Cruz]. / Ablação por cateter de taquiarritmias. Experiência do Hospital de Santa Cruz.

BACKGROUND: First results of tachyarrhythmia's direct current (DC) and radiofrequency (RF) catheter ablation in Portugal (St. Cruz Hospital, Carnaxide). POPULATION AND METHODS: Retrospective analysis of the first 20 patients (P) submitted to catheter ablation in our Center: 11 males and 9 females, aging 36 years (SD 14), with drug-refractory symptomatic tachyarrhythmias. DC ablation was used in the first case and RF current in the nineteen subsequent P. RESULTS: Accessory pathway RF ablation: 92% successful rate (12/13 P); AV nodal modification: fast pathway--1 P (DC ablation), slow pathway--3 P (RF ablation) with one case of late clinical recurrence; two successful His bundle ablation (in paroxysmal atrial flutter/fibrillation) one standard right side and other from left ventricle outflow; one successful RF ablation of a verapamil-sensitive ventricular tachycardia. The mean follow-up was 3.5 months (1 to 7 months for RF and 20 months for DC ablation). CONCLUSIONS: Catheter ablation (mainly RF current) is highly effective in tachyarrhythmia's suppression, with 90% global success in our experience without morbidity.

Comparison of the effects of a controlled-release formulation of isosorbide-5-mononitrate and conventional isosorbide dinitrate on exercise performance in men with stable angina pectoris.

Thirty-three men with stable exercise-induced angina pectoris entered a randomized, double-blind, crossover study in which controlled-release isosorbide-5-mononitrate 60 mg once daily was compared with conventional isosorbide dinitrate 20 mg 3 times daily. Each drug was given for 2 weeks. Twenty-eight patients completed the study and data on exercise variables are available in 23 patients. Treatment with either drug resulted in significant antianginal effects, when measured 6 hours after a single dose and after 2 weeks of therapy compared with baseline placebo; however, there were significantly fewer signs of myocardial ischemia during treatment with isosorbide-5-mononitrate. There was no evidence of tolerance to either drug treatment but a significant attenuation of resting blood pressure (but not of exercise blood pressure) was observed with both drugs. Headache was the only clinically significant adverse event during therapy and it occurred more frequently in the isosorbide dinitrate treatment group (p less than 0.05 vs placebo); 3 such patients had to withdraw from the study because of headache. Thus, once-daily, controlled-release isosorbide-5-mononitrate appears as effective as conventional isosorbide dinitrate 3 times daily in patients with stable angina pectoris. The once-daily administration is convenient and improves patient compliance.

[Pulmonary valvotomy in adults. The double balloon technic--apropos of 2 cases]. / Valvulotomia pulmonar em adultos. Técnica de duplo balão--a propósito de dois casos.

Percutaneous double balloon valvotomy was performed in two adult patients with severe non dysplasic pulmonary valvular stenosis. The balloons were introduced through two 14F sheaths placed in the right and left femural veins, the intervention was well tolerated and succeeded with a marked decrease in right ventricular pressure and in pulmonary transvalvular gradient (113 and 147 mmHg to 10 and 12 mmHg respectively). The patients were discharged within 24 hours, without the need of Intensive Care admission. Indications for the procedure and technical aspects are presented, as well as the potential advantages of two balloons over one balloon and surgical valvotomy.

[Percutaneous mitral valvotomy]. / Valvulotomia mitral por via percutânea.

We report the first percutaneous mitral valvotomy performed in Portugal in October 19th 1987. The valvotomy was attempted successfully in a 34 year old man, with calcific mitral stenosis, in NYHA class III, with functional mitral valve area less then 1 cm2. The intervention was performed using the transseptal technique with two balloons (20 and 18 mm in diameter), placed in the mitral valve annulus through two long transseptal sheaths (14F). The procedure resulted in a marked decrease in the diastolic transmitral gradient, and an increase in mitral valve area superior to 100%. No immediate or late complications were observed, namely mitral regurgitation or left to right shunt through the atrial septum. One year later the patient is in NYHA class I, with a mitral valve area of 1.7 cm2.