Avaliação do estresse e do desempenho de suínos na fase de creche, empregando-se técnicas de enriquecimento ambiental / Evaluation of stress and performance of pigs during the nursery phase, using environmental enrichment techniques

O enriquecimento ambiental é uma ferramenta importante dentro dos sistemas de produção, a fim de promover o bem-estar e favorecer a saúde dos animais. Portanto, o objetivo deste trabalho foi avaliar o efeito do enriquecimento ambiental sobre o estresse de suínos na fase de creche. Foram utilizados 32 leitões, alojados em granja experimental, distribuídos em quatro grupos (n= 8): corda, corrente, garrafa PET e controle negativo. Amostras de sangue foram coletadas no início e no final do experimento para contagem de leucócitos circulantes e determinação de antioxidantes não enzimáticos, óxido nítrico, malondialdeído, e de saliva para avaliação do cortisol. Foi aplicado etograma e fez-a ganho médio de peso diário e a conversão alimentar. Os parâmetros avaliados no primeiro dia do experimento não variaram entre os grupos (P>0,05). No último dia do experimento, os valores de neutrófilos e da relação neutrófilo/linfócito foram mais elevados nos leitões do grupo corrente, assim como os valores de cortisol salivar (P<0,05). O ácido úrico apresentou-se mais elevado nos leitões do grupo corrente e o malondialdeído (MDA) nos do grupo garrafa (P< 0,05). Os enriquecimentos ambientais estimularam comportamentos positivos nos leitões, tendo a corda se destacado como o mais atrativo. Por outro lado, a corrente apresentou efeito negativo sobre a fisiologia dos animais, gerando estresse, assim como a garrafa, que induziu a peroxidação lipídica e um menor ganho de peso nos leitões.(AU)

Environmental enrichment is an important tool within production systems to promote welfare and animal health. The aim of this study was to evaluate the effect of enrichment objects on stress of piglets in nursery phase. 32 piglets housed in experimental farm were distributed in 4 groups (n= 8): rope, chain, pet bottle and negative control. Blood samples were collected at the beginning and end of the experiment to count circulating leukocytes and determine non-enzymatic antioxidants, nitric oxide, malondialdehyde, and saliva to evaluate cortisol. At the same time, an etogram and evaluation of mean daily gain and feed conversion were applied. The evaluated parameters on first day of the experiment did not vary between groups (P> 0.05). On the last day, neutrophil and neutrophil /lymphocyte ratios were higher in chain group piglets, as were salivary cortisol values (P< 0.05). Uric acid was higher in chain group and MDA in bottle group (P< 0.05). Environmental enrichment stimulated positive behaviors in piglets, where the rope stood out as the most attractive. On the other hand, chain had a negative effect on animal physiology, generating stress, as well as the bottle that induced lipid peroxidation and a lower weight gain in piglets.(AU)

Histopathological characterization of experimentally induced cutaneous loxoscelism in rabbits inoculated with Loxosceles similis venom

Envenomation by Loxosceles bites is characterized by dermonecrotic and/or systemic features that lead to several clinical signs and symptoms called loxoscelism. Dermonecrotic lesions are preceded by thrombosis of the dermal plexus. Recent studies show that atheromatous plaque is prone to thrombosis due to endothelial cell apoptosis. To the best of our knowledge, there are no reports of microscopic dermal lesion and endothelial cell apoptosis induced by Loxosceles similis venom in the literature. Thus, the aim of the present study is to describe histological lesions induced by L. similis venom in rabbit skin and to elucidate whether apoptosis of endothelial cells is involved in the pathogenesis of loxoscelism. Forty male rabbits were split into two groups: the control group (intradermally injected with 50 µL of PBS) and the experimental group (intradermally injected with 0.5 µg of L. similis crude venom diluted in 50 µL of PBS). After 2, 4, 6 and 8 hours of injection, skin fragments were collected and processed for paraffin or methacrylate embedding. Sections of 5 µm thick were stained by HE, PAS or submitted to TUNEL reaction. Microscopically, severe edema, diffuse heterophilic inflammatory infiltrate, perivascular heterophilic infiltrate, thrombosis, fibrinoid necrosis of arteriolar wall and cutaneous muscle necrosis were observed. Two hours after venom injection, endothelial cells with apoptosis morphology were evidenced in the dermal plexus. Apoptosis was confirmed by TUNEL reaction. It seems that endothelial cell apoptosis and its consequent desquamation is an important factor that induces thrombosis and culminates in dermonecrosis, which is characteristic of cutaneous loxoscelism.

Cell proliferation markers in the transplanted canine transmissible venereal tumor / Marcadores de proliferação celular no tumor venéreo transmissível canino transplantado

Adult male mongrel dogs were subcutaneously transplanted with the canine transmissible venereal tumor (TVT) on the hypogastric region. Twelve specimens of tumors were collected, half during the proliferative phase and the other half during the regressive phase. Fragments of the tumor were fixed in 10 percent buffered formalin and routinely processed for light microscopy. Sections of 4µm were stained by Schorr or AgNOR or either immunostained for MIB1 (Ki67). Schorr stain, AgNOR and MIB1 showed an increased proliferative activity through mitotic index, nuclear argyrophilic protein stain and cycling tumoral cells in the growing tumors, respectively. All of the three cell proliferation markers were able to distinguish the TVT in both evolution phases. MIB1 monoclonal antibody was the best in the morphologic evaluation of growth and regression of TVT. This resulted in higher values than AgNORs counting and mitotic index. MIB1 immunostaining was the most effective parameter of the proliferative activity of TVT. However, a significant correlation has been detected only between mitosis counting and AgNORs.

Cães machos, adultos, mestiços, foram transplantados com células do tumor venéreo transmissível canino (TVTC), na região hipogástrica. Foram coletados doze espécimes do TVTC, sendo metade durante a fase proliferativa e metade durante a fase regressiva. Fragmentos do tumor foram fixados em formol a 10 por cento, tamponado e processado rotineiramente para microscopia de luz. Secções de 4µm foram coradas pelo Shorr, ou pela AgNOR, ou ainda, imunocorado para MIB 1 (Ki67). As colorações pelo Shorr, AgNOR, ou MIB 1 mostraram um aumento do índice mitótico, coloração da proteína argirofílica nuclear e células tumorais ciclando em tumores em crescimento, respectivamente. Todos os três marcadores de proliferação celular foram capazes de distinguir o TVTC em ambas as fases de evolução. O anticorpo monoclonal MIB 1 foi o melhor na avaliação morfológica, de crescimento e regressão do TVTC. Isto resultou em um valor maior que a contagem de AgNOR e do índice mitótico. A imunomarcação com MIB1 foi o parâmetro mais efetivo da atividade proliferativa. No entanto, só foi observada uma correlação positiva entre a contagem de mitose e a AgNOR.

Síndrome de Kartagener em um cão (Canis lupus familiaris) da raça Cocker Spaniel Inglês / Kartagener's syndrome in an English Cocker Spaniel dog (Canis lupus familiaris)

Kartagener is syndrome is a rare disorder described in dogs determined by the triad situs inversus totalis, chronic sinusitis, and bronchial disease. The clinical signs of chronic respiratory and other less common presentations (such as hydrocephalus and subfertility) are due to a concomitant ciliary dysfunction. This article describes the clinical, radiographic, and computed tomography findings and treatment in a dog affected by Kartagener is syndrome since early months of life. This is the first case report of this syndrome in a domestic dog in Brazil and the only known scientific report in the English Cocker Spaniel.

Detection of cancer in cervical tissue biopsies using mobile lipid resonances measured with diffusion-weighted (1)H magnetic resonance spectroscopy.

The purpose of this study was to implement a diffusion-weighted sequence for visualisation of mobile lipid resonances (MLR) using high resolution magic angle spinning (HR-MAS) (1)H MRS and to evaluate its use in establishing differences between tissues from patients with cervical carcinoma that contain cancer from those that do not. A stimulated echo sequence with bipolar gradients was modified to allow T(1) and T(2) measurements and optimised by recording signal loss in HR-MAS spectra as a function of gradient strength in model lipids and tissues. Diffusion coefficients, T(1) and apparent T(2) relaxation times were measured in model lipid systems. MLR profiles were characterised in relation to T(1) and apparent T(2) relaxation in human cervical cancer tissue samples. Diffusion-weighted (DW) spectra of cervical biopsies were quantified and peak areas analysed using linear discriminant analysis (LDA). The optimised sequence reduced spectral overlap by suppressing signals originating from low molecular weight metabolites and non-lipid contributions. Significantly improved MLR visualisation allowed visualisation of peaks at 0.9, 1.3, 1.6, 2.0, 2.3, 2.8, 4.3 and 5.3 ppm. MLR analysis of DW spectra showed at least six peaks arising from saturated and unsaturated lipids and those arising from triglycerides. Significant differences in samples containing histologically confirmed cancer were seen for peaks at 0.9 (p < 0.006), 1.3 (p < 0.04), 2.0 (p < 0.03), 2.8 (p < 0.003) and 4.3 ppm (p < 0.0002). LDA analysis of MLR peaks from DW spectra almost completely separated two clusters of cervical biopsies (cancer, 'no-cancer'), reflecting underlying differences in MLR composition. Generated Receiver Operating Characteristic (ROC) curves and calculated area under the curve (0.962) validated high sensitivity and specificity of the technique. Diffusion-weighting of HR-MAS spectroscopic sequences is a useful method for characterising MLR in cancer tissues and displays an accumulation of lipids arising during tumourigenesis and an increase in the unsaturated lipid and triglyceride peaks with respect to saturated MLR.

Apoptosis in the transplanted canine transmissible venereal tumor during growth and regression phases / Apoptose no tumor venéreo transmissível canino durante as fases de crescimento e regressão

Twelve male, mongrel, adult dogs were subcutaneously transplanted with cells originated from two canine transmissible venereal tumors (TVT). The aim was to demonstrate and to quantify the occurrence of apoptosis in the TVT regression. After six months of transplantation, a tumor sample was obtained from each dog, being six dogs with TVT in the growing phase and six in the regression phase as verified by daily measurements. Samples were processed for histological and ultrastructural purposes as well as for DNA extraction. Sections of 4µm were stained by HE, Shorr, methyl green pyronine, Van Gieson, TUNEL reaction and immunostained for P53. The Shorr stained sections went through morphometry that demonstrated an increase of the apoptotic cells per field in the regressive tumors. It was also confirmed by transmission electron microscopy, which showed cells with typical morphology of apoptosis and by the TUNEL reaction that detected in situ the 3'OH nick end labeling mainly in the regressive tumors. The regressive TVTs also showed an intensified immunostaining for P53 besides a more intense genomic DNA fragmentation detected by the agarose gel electrophoresis. In conclusion, apoptosis has an important role in the regression of the experimental TVT in a way that is P53-dependent.

Doze cães, adultos, machos e sem raça definida foram transplantados subcutaneamente, na região hipogástrica, com células originadas de dois tumores venéreos transmissíveis caninos (TVT). O objetivo do estudo foi demonstrar e quantificar a ocorrência de apoptose na regressão do TVT. Após seis meses, foi obtido um tumor de cada animal, totalizando seis em crescimento e seis em regressão. Fragmentos dos tumores foram processados para avaliação histológica, ultra-estrutural e também para extração de DNA. Cortes de 4µm foram corados em HE, Shorr, verde de metila pironina e Van Gieson e alguns foram submetidos à reação do TUNEL e à imunoistoquímica para P53. Secções coradas pelo Shorr, submetidas à morfometria, demonstram maior índice apoptótico nos tumores em regressão. Esse achado foi confirmado pela microscopia eletrônica de transmissão que evidenciou células com morfologia típica de apoptose e pela reação de TUNEL que marcou mais células nos tumores em regressão que naqueles em crescimento. A imunomarcação para P53 foi mais intensa nos tumores em regressão, assim como a fragmentação internucleossômica do genoma mostrada pela eletroforese em gel de agarose. Concluiu-se que a apoptose tem importante papel na regressão do TVT transplantado experimentalmente, sendo, nesse caso, dependente de P53 para a sua execução.

Virulence insights from the Paracoccidioides brasiliensis transcriptome

Paracoccidioides brasiliensis, the etiologic agent of paracoccidioidomycosis, is a dimorphic fungus, which is found as mycelia at 22-26 degrees C and as yeasts at 37 degrees C. A remarkable feature common to several pathogenic fungi is their ability to differentiate from mycelium to yeast morphologies, or vice-versa. Although P. brasiliensis is a recognized pathogen for humans, little is known about its virulence genes. In this sense, we performed a search for putative virulence genes in the P. brasiliensis transcriptome. BLAST comparative analyses were done among P. brasilienses assembled expressed sequence tags (PbAESTs) and the sequences deposited in GenBank. As a result, the putative virulence PbAESTs were grouped into five classes, metabolism-, cell wall-, detoxification-related, secreted factors, and other determinants. Among these, we have identified orthologs of the glyoxylate cycle enzymes, a metabolic pathway involved in the virulence of bacteria and fungi. Besides the previously described alpha- and beta-glucan synthases, orthologs to chitin synthase and mannosyl transferases, also important in cell wall synthesis and stabilization, were identified. With respect to the enzymes involved in the intracellular survival of P. brasiliensis, orthologs to superoxide dismutase, thiol peroxidase and an alternative oxidase were also found. Among the secreted factors, we were able to find phospholipase and urease orthologs in P. brasiliensis transcriptome. Collectively, our results suggest that this organism may possess a vast arsenal of putative virulence genes, allowing the survival in the different host environments.

Paracoccidioides brasiliensis translation and protein fate machineries revealed by functional genome analysis

The translational and post-translational modification machineries of Paracoccidioides brasiliensis were assessed by means of comparative analyses of PbAESTs (P. brasiliensis assembled expressed sequence tags) with sequences deposited on different databases. Of the 79 sequences corresponding to cytosolic ribosomal proteins, we were able to find 78 in the P. brasiliensis transcriptome. Nineteen of the 27 Saccharomyces cerevisiae genes related to translation initiation were also found. All eukaryotic elongation factors were detected in P. brasiliensis transcriptome, with eEF1A as one of the most expressed genes. Translation termination is performed, in eukaryotes, by factors 1 and 3 (eRF1, eRF3). In P. brasiliensis transcriptome it was possible to identify eRF3, but not eRF1. Sixteen PbAESTs showing aminoacyl-tRNA synthetase-predicted activities were found in our analyses, but no cysteinyl-, leucyl-, asparagyl- and arginyl-tRNA synthetases were detected. Among the mitochondrial ribosomal proteins, we have found 20 and 18 orthologs to S. cerevisiae large and small ribosomal subunit proteins, respectively. We have also found three PbAESTs similar to Neurospora crassa mitochondrial ribosomal genes, with no similarity with S. cerevisiae genes. Although orthologs to S. cerevisiae mitochondrial EF-Tu, EF-G and RF1 have been found in P. brasiliensis transcriptome, no sequences corresponding to functional EF-Ts were detected. In addition, 64 and 28 PbAESTs associated to protein modification and degradation, respectively, were found. These results suggest that these machineries are well conserved in P. brasiliensis, when compared to other organisms.

A model of chronic IgE-mediated food allergy in ovalbumin-sensitized mice

Food allergy is most frequently the result of IgE-mediated hypersensitivity reactions. Here, we describe a chronic model in which some of the intestinal and systemic consequences of continuous egg white solution ingestion by ovalbumin-sensitized eight-week-old BALB/c mice, 6 animals per group, of both sexes, were investigated. There was a 20 percent loss of body weight that began one week after antigen exposure and persisted throughout the experiment (3 weeks). The sensitization procedure induced the production of anti-ovalbumin IgG1 and IgE, which were enhanced by oral antigen exposure (129 percent for IgG1 and 164 percent for IgE, compared to sensitization values). Intestinal changes were determined by jejunum edema at 6 h (45 percent Evans blue extravasation) and by a significant eosinophil infiltration with a peak at 48 h. By day 21 of continuous antigen exposure, histological findings were mild, with mast cell hyperplasia (100 percent) and increased mucus production (483 percent). Altogether, our data clearly demonstrate that, although immune stimulation was persistently occurring in response to continuous oral antigen exposure, regulatory mechanisms were occurring in the intestinal mucosa, preventing overt pathology. The experimental model described here reproduces the clinical and pathological changes of mild chronic food allergy and may be useful for mechanistic studies of this common clinical condition.

Immune and hormonal activity in adults suffering from depression

An association between depression and altered immune and hormonal systems has been suggested by the results of many studies. In the present study we carried out immune and hormonal measurements in 40 non-medicated, ambulatory adult patients with depression determined by CID-10 criteria and compared with 34 healthy nondepressed subjects. The severity of the condition was determined with the Hamilton Depression Rating Scale. Of 40 depressed patients, 31 had very severe and 9 severe or moderate depression, 29 (72.5 percent) were females and 11 (27.5 percent) were males (2.6:1 ratio). The results revealed a significant reduction of albumin and elevation of alpha-1, alpha-2 and beta-globulins, and soluble IL-2 receptor in patients with depression compared to the values obtained for nondepressed subjects (P<0.05). The decrease lymphocyte proliferation in response to a mitogen was significantly lower in severely or moderately depressed patients when compared to control (P<0.05). These data confirm the immunological disturbance of acute phase proteins and cellular immune response in patients with depression. Other results may be explained by a variety of interacting factors such as number of patients, age, sex, and the nature, severity and/or duration of depression. Thus, the data obtained should be interpreted with caution and the precise clinical relevance of these findings requires further investigation

Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae.

BACKGROUND: A new technique is suggested for the reconstructive surgical treatment of mitral regurgitation. It involves partial transfer of the tricuspid valve of the patient to the mitral valve, in order to provide chordae to correct anterior leaflet prolapse of the mitral valve, secondary to rupture of the chordae tendineae. METHODS: From January 1991 to May 1997, 20 patients with mitral insufficiency due to rupture of the chordae were operated on. The prevailing cause was myxomatous degeneration (70%). Patients were in New York Heart Association functional class III and IV. RESULTS: There were no hospital deaths. Two patients were reoperated on. Eighteen patients (90%) are alive with their own valves (class I and II). Doppler echocardiogram mean values were: ejection fraction, 0.65; left atrial diameter, 4.2 cm; mitral area, 2.4 cm2; mitral transvalvular gradient, 3.3 mm Hg. No regurgitation or mild regurgitation was observed in 16 (94.1%) of the 17 cases evaluated. Mean tricuspid valvular area was 3.3 cm2. In all cases, no tricuspid regurgitation was present or it was mild. CONCLUSIONS: Partial transfer of the tricuspid valve to the mitral valve is an effective procedure for the surgical treatment of mitral valve insufficiency secondary to ruptured chordae tendineae of the anterior leaflet.

Detection of genomic variability in different populations of the cattle tick Boophilus microplus in southern Brazil.

DNA from seven isolates of the cattle tick Boophilus microplus was analyzed by restriction fragment length polymorphism (RFLP). Three different cDNA clones, named P-9, P-25 and CP-12, isolated from a B. microplus cDNA library, were used as DNA probes. DNA sequences of P-9 have high similarity to ribosomal genes, whereas P-25 does not show significant homology with known sequences within databases. CP-12 is a cDNA clone encoding a cysteine endopeptidase gene. A limited degree of polymorphism was detected with P-9 and P-25, while CP-12 showed a different pattern of bands for each tick isolate. These findings suggest the existence of a complex genotypic diversity of the tick B. microplus population in endemic regions.

Aplasia cutis congenita in an infant of an initial triplet gestation: a case report.

Aplasia cutis congenita (ACC) is the clinical manifestation of an uncommon group of skin disorders. One postulated etiology is disseminated intravascular coagulation from release of thrombogenic maternal arising from placental injury or fetal demise. This leads to disruption of the ectodermal blood supply responsible for the skin defects. We present a neonate with group V ACC, one of an initial triplet gestation, associated with fetal demise at 14 weeks and formation of a fetus papyraceus. The practice of selective fetal reduction as a result of multiple gestation seen with the use of fertility drugs may in theory increase the incidence of group V ACC.

[Immediate and late results of the surgical treatment of the aneurysms and dissections of the ascending aorta]. / Resultados imediatos e tardios do tratamento cirúrgico dos aneurismas e dissecções da aorta ascendente.

PURPOSE: To report our experience and results with the surgical treatment of aortic aneurysms and dissections of the ascending aorta as well as the techniques that have been used. METHODS: Between May 1982-May 1995, 54 patients were operated on and divided in two groups: group A was composed of 25 patients with aneurysms or chronic dissections of the ascending aorta. The Bentall and DeBonno procedure was performed in 18, five were submitted to prosthetic aortic graft associated with aortic valve replacement and two prosthetic aortic graft without aortic valve replacement. Group B had 29 patients with acute dissections of the ascending aorta (type A) who were submitted to 10 prosthetic graft alone, nine Bentall procedures, five prosthetic graft with aortic valve replacement, four aortic repair and one direct suture of the dissection. The survival curve was obtained by the Kaplan-Meier method. RESULTS: Total hospital mortality rate was 13% and the late was 18.5%. Group A-immediate mortality rate was 8% (two patients): Low cardiac output and stroke; late mortality rate was five (20%): sudden death in three, pulmonary embolism one and infectious endocardite one. Group B-hospital mortality rate was five (17.2%) patients: low cardiac output three, multiple organs failure one and stroke with pneumonia one; late mortality rate was five (17.2%), distal redissection in three, sudden death in two. The average survival time was 86 +/- 12 for group A and 75 +/- 13 months for group B. CONCLUSION: The surgery of the aneurysm and dissections of the ascending aorta has shown immediate favorable results and a thorough follow-up to get better late results is needed.

Cox maze operation without cryoablation for the treatment of chronic atrial fibrillation.

BACKGROUND: From August 1993 to May 1994, 20 patients (mean age, 43 years) with atrial fibrillation underwent the maze operation without cryoablation. Ten patients had mitral stenosis, 5 had mitral insufficiency, and 5 had a mixed mitral lesion. The mean left atrial diameter as measured on echocardiograms was 6.1 cm. The cause was rheumatic in 17 patients (85%) and degenerative in 3 (15%). Seven patients had had previous episodes of thromboembolism. METHODS: Mitral valvuloplasty was performed on 7 patients, mitral commissurotomy on 4, and mitral valve replacement on 9. Thrombi were found in the left atrium of 7 patients and also in the right atrium in 2. The mean cross-clamp time was 73 minutes (range, 52 to 108 minutes). RESULTS: Patients were discharged from the hospital in good condition. Hemodynamic studies and Doppler echocardiograms showed significant reduction in the left atrial diameter (mean diameter, 4.9 cm; p < 0.01) in 18 patients. The two-channel Holter monitor showed sinus rhythm in 15 patients, atrial ectopic rhythm in 4, and atrial fibrillation in 1. Eleven patients (55%) experienced atrial fibrillation (9 in the first 3 months postoperatively), which was reversed with quinidine. Ninety percent of patients had development of an effective, synchronous, atrial systole. Six to 15 months postoperatively (average follow-up, 10 months), all patients were in functional class I, and 18 were not on a regimen of antiarrhythmic medication. CONCLUSIONS: This simplification of the maze operation has been demonstrated to be an effective alternative for the treatment of chronic atrial fibrillation.

[Use of tranexamic acid for bleeding control in myocardial revascularization]. / Emprego do ácido tranexâmico para controle de sangramento em cirurgia de revascularização miocárdica.

PURPOSE: To compare two groups of 80 patients undergoing to myocardial revascularization with the use of antifibrinolytic drug tranexamic acid and its efficacy in reduce bleeding and blood transfusion. METHODS: Prospective analysis of two groups of 80 patients. Group A-no antifibrinolytic therapy (dec 91-may 92) and group B-fibrinolytic therapy-tranexamic acid-10g EV (jun-dec/92). Quantification of mediastinal drainage over 12h as well as the blood or derivatives received at the same time. RESULTS: Hospital mortality: group A-3.8%, group B-2.5%. Drainage (12h): group A-602 +/- 547 ml and group B-260 +/- 260 ml (p < 0.001). Blood transfusion (12h): group A-1,782 +/- 1,163 ml and group B-1,105 +/- 839 ml (p < 0.001). COMPLICATIONS: group A-two cases of intraoperative myocardial infarction, one episode of jaundice; group B-one case of intraoperative MI, one reoperation for bleeding control, one episode of jaundice, one of renal insufficiency, two mediastinitis and one seizure. The mean hospitalization time was ten days in both groups. CONCLUSION: Tranexamic acid was an effective drug in bleeding control and in reducing blood transfusion in the postoperative of patients submitted to myocardial revascularization.

Modified technique for total cavopulmonary connection.

The laterolateral anastomosis between the superior vena cava and the pulmonary artery trunk is presented as a modified technique for total cavopulmonary connection. This procedure was successfully performed on a 9-year-old girl, associated with the exclusion of the right atrium, for the treatment of tricuspid atresia and transposition of the great arteries.

Mitral valvuloplasty with a new prosthetic ring. Analysis of the first 105 cases.

From October 1987 to March 1993, 105 patients were studied who have undergone valvuloplasty with an open ring. They ranged from 5 to 79 years (mean 30); 33 (31.4%) were under 16. All patients had mitral insufficiency, alone in 62 (59.0%) and associated with mitral stenosis (double mitral lesion) in 43 (41.0%). In the majority of the cases, the aetiology was rheumatic (78.1%); active in 10 (9.5%) patients. Three patients (2.9%) were in class II, 42 (40.0%) in class III, 57 (54.3%) in class IV and 3 (2.9%) in class V. Ten patients (9.5%) had isolated ring implantation while the remaining underwent associated procedures on the leaflets, chordae and papillary muscles. There were two (1.9%) hospital deaths, and six patients (5.7%) had to be reoperated. On the 30th (mean) postoperative day, 75 (71.4%) patients were reevaluated by catheterization, echo Doppler or both to confirm the effectiveness of the techniques employed. The mitral valve was functioning normally or with mitral regurgitation + in 63 (84.0%) patients, mitral regurgitation + + in 2 (2.7%), mitral regurgitation + + + in 5 (6.7%), mitral stenosis + in 4 (5.3%), and mitral stenosis + + in 1 (1.3%) patient. The results were therefore considered excellent in 63 (84.0%) patients with either normal mitral valve or mitral regurgitation +, good in 6 (8.0%) patients with mitral regurgitation + + and/or mitral stenosis +, and poor in 6 (8.0%) patients with mitral regurgitation + + + and/or mitral stenosis + +. Two deaths (1.9%) occurred within the first 7 months of follow-up. Patients were evaluated clinically 1-67 months postoperatively (mean 27):90 (85.7%) were in class I, 4 (3.8%) in class II, 4 (3.8%) in class III and 1 (1.0%) in class IV.(ABSTRACT TRUNCATED AT 250 WORDS)