Use of rosiglitazone before and after vascular injury in hypercholesterolemic rabbits: Assessment of neointimal formation.

OBJECTIVES: To analyse the effects of rosiglitazone administered at different times on neointimal formation in hypercholesterolemic rabbits following vascular injury. METHODS: Thirty-nine rabbits on a hypercholesterolemic diet were included. The animals underwent balloon catheter injury to the right iliac artery on day 14. They were divided into three groups as follows: control group, 13 rabbits without rosiglitazone; group I, 13 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) for 28 days after the vascular injury; and group II, 13 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during all the experiment (42 days). Histological analysis was done by an experienced pathologist who was unaware of the rosiglitazone treatment. Histomorphometric parameters were performed by calculation of the luminal and intimal layer area, and intima/media layer area ratio (the area of the intimal layer divided by the area of the medial layer). RESULTS: Intimal area was significantly lower in group II vs. CG (p = 0.024) and group I (p = 0.006). Luminal layer area was higher in group II vs. CG (p < 0.0001) and group I (p < 0.0001). Intima/media layer area ratio was equal between CG and group I. Intima/media layer ratio area was significantly lower in group II vs. control group (p < 0.021) and group I (p < 0.003). There was a significant reduction of 65% and 71% in intima/media layer area ratio in group II vs. control group and group I, respectively. CONCLUSION: Pretreatment with rosiglitazone in hypercholesterolemic rabbits submitted to vascular injury significantly reduces neointimal formation.

Effects of rosiglitazone on contralateral iliac artery after vascular injury in hypercholesterolemic rabbits.

BACKGROUND: The objective was to evaluate the effects of rosiglitazone on iliac arteries of hypercholesterolemic rabbits undergoing balloon catheter injury in the contralateral iliac arteries. METHODS: White male rabbits were fed a hypercholesterolemic diet for 6 weeks and divided into two groups as follows: rosiglitazone group, 14 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during 6 weeks; and control group, 18 rabbits without rosiglitazone treatment. All animals underwent balloon catheter injury of the right iliac artery on the fourteenth day of the experiment. RESULTS: There was no significant difference in intima/media layer area ratio between the control group and the rosiglitazone group. Rosiglitazone did not reduce the probability of lesions types I, II, or III (72.73% vs. 92.31%; p = 0.30) and types IV or V (27.27% vs. 7.69%; p = 0.30). There were no differences in the extent of collagen type I and III deposition or in the percentage of animals with macrophages in the intima layer. The percentage of rabbits with smooth muscle cells in the intima layer was higher in rosiglitazone group (p = 0.011). CONCLUSION: These findings demonstrate that rosiglitazone given for 6 weeks did not prevent atherogenesis at a vessel distant from the injury site.

Appropriateness of carotid plaque and intima-media thickness assessment in routine clinical practice.

OBJECTIVES: To describe the findings and evaluate appropriateness of a carotid artery study including the measurement of IMT, the presence of atherosclerotic plaque, and their correlation with cardiovascular risk factors. METHODS: 555 patients (220 men; 67.06 +/- 12.44 years) were included in the study. 120 patients (21.62%) presented carotid plaque: 108 (19.45%) in patients with at least one risk factor and 12 (2.1%) in patients without risk factors. With respect to appropriateness of the present studies: 65% were appropriate, 22% were uncertain and 13% were inappropriate. The IMT medians were higher in males (0.0280; 95% CI, 00.82 to 0.478; p = 0.0057) and in hypertensive patients (0.391; 95% CI, 0.0190 to 0.0592; p = 0,001). There was a linear increase in mean IMT for each year increased in age (0.0059; 95% CI; 0.0050 to 0.0067). Carotid plaque was more frequent in patients with CAD (p = 0.0002), diabetes (p = 0.024) and hypertension (p = 0.036). CONCLUSION: Assessment of carotid arteries identified increased incidence of plaque in patients with CAD, diabetes and hypertension. IMT was increased in older patients, hypertensive patients and males. Forty-five percent of the patients were studied based on uncertain and inappropriate reasons.

A percepção e conduta sobre a medida da pressão arterial em pacientes com neoplasia de mama em cardiologistas e mastologistas / The perception and management of blood pressure measurement in patients with breast cancer in cardiologists and mastologistas

Embora pacientes submetidas ao tratamento cirúrgico para Neoplasia de Mama, de modo geral e frequente, recebam orientações para não medir a pressão arterial no braço homolateral ao seu tratamento, devemos reavaliar contemporaneamente e cientificamente estas recomendações. O propósito deste trabalho é demonstrar os dados de Medicina Baseada em Evidências e considerar a evolução da abordagem cirúrgica neste grupo de pacientes, atualizando estas recomendações e demostram dados de enquete sobre o assunto entre médicos de diferentes especialidades. Há suficiente suporte científico e explicações para que orientemos de forma individualizada e coerentemente estas pacientes em relação a medida da pressão arterial e consequentemente sua relação com o aparecimento do linfedema no braço homolateral, porém a Sociedade Brasileira de Cardiologia, pelo seu Departamento de Hipertensão Arterial não tem recomendações sobre este assunto. Que deve ser contextualizado devido a má percepção sobre o assunto, em repostas a uma enquete feita com Cardiologistas e Mastologistas sobre este tema (AU)

Although patients undergoing surgical treatment for breast cancer are often advised against measuring blood pressure in the arm on the same side as their treatment, it is crucial to reevaluate these recommendations using contemporary and scientific evidence. The objective of this study is to present empirical data on Evidence-Based Medicine and explore the evolving surgical approaches in this patient population. By updating these recommendations and showcasing survey results from physicians across different specialties, we aim to provide comprehensive guidance on the topic. While there is ample scientific support and explanations to individually and coherently guide these patients regarding blood pressure measurement and its potential association with lymphedema in the affected arm, it is important to note that the Brazilian Society of Cardiology, specifically its Department of Arterial Hypertension, does not currently offer recommendations on this matter. This contextualization is necessary due to the limited awareness and understanding of the subject, as revealed through responses obtained from Cardiologists and Mastologists participating in our survey.

Retroperitoneal fetus in fetu in a 65-year-old man

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus is incorporated within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. In most cases, the diagnosis is made in infants or young adults. To date, the oldest patient reported in the literature was 47 years old. We describe the case of a 65-year-old patient with FIF, now the oldest reported in the literature. Our patient meets all the diagnostic criteria for FIF, including the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF should be considered in the differential diagnosis of abdominal masses, typically recognized in infancy. Symptoms arise from mass effects. Surgical resection should be performed due to the potential for malignant transformation.

Influence of quality of sleep on the nocturnal decline in blood pressure during ambulatory blood pressure monitoring.

OBJECTIVE: To assess the influence of the quality of sleep on the nocturnal physiological drop in blood pressure during ambulatory blood pressure monitoring. METHODS: We consecutively assessed ambulatory blood pressure monitoring, the degree of tolerance for the examination, and the quality of sleep in 168 patients with hypertension or with the suspected "white-coat" effect. Blood pressure fall during sleep associated with a specific questionnaire and an analogical visual scale of tolerance for ambulatory blood pressure monitoring were used to assess usual sleep and sleep on the day of examination. Two specialists in sleep disturbances classified the patients into 2 groups: those with normal sleep and those with abnormal sleep. RESULTS: Fifty-nine (35 %) patients comprised the abnormal sleep group. Findings regarding the quality of sleep on the day of ambulatory blood pressure monitoring as compared with those regarding the quality of sleep on a usual day were different and were as follows, respectively: total duration of sleep (-12.4 +/- 4.7 versus -42.2 +/- 14.9 minutes, P=0.02), latency of sleep (0.4 +/- 2.7 versus 17 +/- 5.1 minutes, P<0.001), number of awakenings (0.1 +/- 0.1 versus 1.35 +/- 0.3 times, P<0.001), and tolerance for ambulatory blood pressure monitoring (8 +/- 0.2 versus 6.7 +/- 0.35, P=0.035). An abnormal drop in blood pressure during sleep occurred in 20 (18%) patients in the normal sleep group and in 14 (24%) patients in the abnormal sleep group, P=0.53. CONCLUSION: Ambulatory blood pressure monitoring causes sleep disturbances in some patients, and a positive association between quality of sleep and tolerance for the examination was observed.

Obstruction of the left ventricular outflow tract after mitral valvuloplasty with implantation of Gregori's ring.

Mitral valvuloplasty is efficient for repairing mitral valve disease with few complications. In some cases, obstruction of the left ventricular outflow tract may occur due to systolic anterior motion of the mitral valve. We report the case of a patient with this complication and a pressure gradient between the left ventricle and the aorta of 130 mm Hg after mitral valvuloplasty with implantation of a Gregori's ring. The management was clinical with suspension of the vasoactive drugs and introduction of a beta-blocker. Two years after the surgery, the patient is asymptomatic and has a normal life.

Risk stratification by accelerated high-dose dipyridamole stress echocardiography in patients over 70 years of age.

BACKGROUND: The non-invasive prognostic assessment of coronary artery disease in patients over 70 years old is an important goal in daily clinical practice. OBJECTIVES: To retrospectively assess the feasibility, the positive and negative predictive values and the accuracy of accelerated high-dose dipyridamole stress echocardiography in patients over 70 years old. METHODS: Three hundred seventy nine patients (226 women; mean age of 75.9±4.6 years) underwent dipyridamole stress echocardiography. RESULTS: Follow-up data were available for 313 patients (mean follow-up duration 21±15.7 months). Overall feasibility was 97%. Positive predictive values were 30% and 40% for 6 and 12 months of follow-up, respectively. Negative predictive values were 97.7% and 96.7% for 6 and 12 months of follow-up, respectively. Accuracy values were 95.5% and 94.9% for 6 and 12 months of follow-up, respectively. Among the clinical variables, dyslipidemia (OR 5.3; CI 95% 1.3-20.9; p=0.016), coronary artery disease (OR 4.2; CI 95% 1.3-13.3; p=0.014) and a positive stress echo response (OR 9.0; CI 95% 1.7-49.1; p=0.011) were independently associated with the occurrence of a cardiovascular event. A Cox regression model showed that male gender and a positive stress echo response significantly predicted death. CONCLUSIONS: Risk stratification with accelerated high-dose dipyridamole stress echocardiography is feasible in patients over 70 years old. A positive stress echo response, the presence of coronary artery disease, and dyslipidemia positively predicted the occurrence of cardiovascular events. Male gender and a positive stress echo response significantly predicted death.

Sclerochorioretinal abnormalities in hypercholesterolemic rabbits treated with rosiglitazone.

BACKGROUND AND OBJECTIVE: To evaluate early retinal, choroidal, and scleral abnormalities induced by a hypercholesterolemic diet and the prevention of these abnormalities after oral administration of rosiglitazone in rabbits. MATERIALS AND METHODS: Fifty-four New Zealand rabbits were divided into four study groups: control group, normal diet; group 1, hypercholesterolemic diet; group 2, hypercholesterolemic diet associated with daily administration of 3 mg of rosiglitazone from day 14 after beginning the diet; and group 3, hypercholesterolemic diet associated with daily administration of 3 mg of rosiglitazone since the beginning of the experiment. Sclera and choroid underwent histologic and histomorphometric analyses. Retina underwent immunohistochemical analysis with anti-calretinin and anti-glial fibrillary acidic protein (GFAP) antibodies. RESULTS: No abnormalities were observed in the control group. Group 1 had significant increases in scleral and choroidal thicknesses compared with the control group (P < .01) and group 3 (P < .05). Group 1 presented significant increases in immunoreactivity (P < .001) to the anti-calretinin antibody compared with the other groups. Groups 2 and 3 had significant (P < .002) increases in calretinin immunoreactivity compared with the control group. GFAP was negative in all groups. CONCLUSION: The hypercholesterolemic diet induced early retinal, choroidal, and scleral abnormalities. Rosiglitazone preserved the structural anatomy.

Rosiglitazone and vascular injury in hypercholesterolemic rabbits: neointimal formation assessment.

BACKGROUND: Rosiglitazone has been the focus of extensive discussion. OBJECTIVE: To evaluate the effects of rosiglitazone on iliac arteries, both at the injury site and the contralateral artery, of hypercholesterolemic rabbits undergoing balloon catheter injury. METHODS: White male rabbits were fed a hypercholesterolemic diet by oral gavage for 6 weeks and divided into two groups as follows: rosiglitazone group (14 rabbits treated with rosiglitazone during 6 weeks) and the control group (18 rabbits without rosiglitazone). Animals underwent balloon catheter injury of the right iliac artery on the 14th day. RESULTS: In the contralateral iliac artery, there was no significant difference in the intima/media layer area ratio (IMR) between the control and rosiglitazone groups. Rosiglitazone did not reduce the probability of type I, II, or III lesions (72.73% vs 92.31%; p=0.30) and type IV or V lesions (27.27% vs 7.69%; p=0.30). As for the homolateral iliac artery, the intimal area was significantly lower in the rosiglitazone group, as compared to the control group (p = 0.024). The luminal layer area was higher in the rosiglitazone group vs. the control group (p < 0.0001). There was a significant reduction of 65% in the IMR in the rosiglitazone group vs the control group (p = 0.021). None of the histological criteria for type I-V atherosclerotic lesions (American Heart Association) were found in the homolateral iliac artery. CONCLUSION: These findings demonstrate that rosiglitazone given for 6 weeks prevents atherogenesis at the injury site, but not in a vessel distant from the injury site.

Avaliação da medida de pressão arterial por meio de equipamento acoplado a smartphone em jovens sadios / Evaluation of the blood pressure determination trough smartphone-linked equipment in healthy young individuals

Na era atual, em que os smartphones vêm ganhando espaço no meio médico, é fundamental a avaliação científica da real eficácia e reprodutibilidade dessas novas tecnologias. Nesse contexto, nosso objetivo foi avaliar, de forma inédita no nosso país, o esfigmomanômetro acoplado ao smartphone (Withings Blood Pressure Monitor) em comparação com outros métodos (esfigmomanômetros de mercúrio, aneroide e digital). Foram selecionados de forma aleatória 45 alunos sadios do curso de Medicina da Universidade Federal do Paraná (UFPR) e realizadas três medidas por aparelho, sendo comparadas entre as quatro modalidades, em ordem aleatória e em cada aluno. Também foi avaliada a preferência de método entre smartphone e digital. Os dados obtidos foram analisados nos modelos t de Student pareado e oneway ANOVA, com significância de p <0,05. Foram obtidas 576 medidas; na comparação individual das medidas, em relação à pressão arterial sistólica (PAS), quando confrontados cada aparelho entre si, o smartphone não apresentou diferença significativa comosdemaismétodos(p>0,05),emcadaleituraporaluno ou entre os diferentes métodos. Quanto à pressão arterial diastólica (PAD), houve diferença significativa entre o smartphone e os demais aparelhos (p < 0,05). Na análise específica das médias repetidas em cada aluno por cada método, em relação à PAD, o smartphone foi o único a diferir significativamente de todos os outros métodos, existindo uma variabilidade entre cada medida. Quanto à análise de preferência, os quesitos tempo de medida, desconforto à compressão do manguito e apresentação visual das medidas não influenciaram significativamente a escolha, sendo que 51,9% optaram pelo smartphone e 29,6%, pelo digital.

Nowadays, when smartphones are increasingly gaining space in the medical environment, the scientific evaluation of the real efficacy and reproducibility of this new technology is essential. In this context, our goal was to evaluate, unprecedently in Brazil, the smartphone-linked sphygmomanometer (Withings Blood Pressure Monitor) in comparison with other methods (mercury, aneroid and digital sphygmomanometers). We randomly selected 45 healthy medical students from Universidade Federal do Paraná (UFPR), and three measures by each modality were taken and compared between them, in random order and on each person. The preference for self-measurement method between digital and smartphone-linked sphygmomanometers was also evaluated. The obtained data were analyzed through paired t-Student and oneway ANOVA models, with significance of p <0.05. We obtained 576 measures; in the individual comparison of them, in relation to the systolic blood pressure (SBP), when the modalities were confronted between each other, the smartphone did not present significant difference with theothermethods(p>0.05)ineachmeasurebystudentorbetween methods. Regarding diastolic blood pressure (DBP), there was significant difference between smartphone and the other modalities (p < 0.05). In the specific analysis of the repeated means in each student by each method, regarding DBP, the smartphone was the only one to significantly differ of the other techniques, existing variability among each measure. Concerning the preference analysis, the matters of measurement time, discomfort of the compressive cuff and visual presentation of the measurements did not significantly influence the final choice, in which 51.9% chose the smartphone and 29.6%, the digital equipment

Esteatose hepática e calcificação coronariana em pacientes assintomáticos portadores de síndrome metabólica / Fatty liver disease and coronary calcification in asymptomatic metabolic syndrome patients

JUSTIFICATIVA E OBJETIVOS: A síndrome metabólica(SM) é preditora de mortalidade e de eventos cardiovasculares. Esteatose hepática (EH), um achado comum na SM, tem sido questionada como um possível marcador de aterosclerose nessa população. O objetivo desse estudo foi avaliar a associação da EH e calcificação coronária em pacientes com SM.MÉTODO: Portadores de SM, não fumantes, de ambos os sexos e sem doença coronária conhecida foram inseridos no presente estudo. Excluíram-se pacientes que usavam estatinas ou medicações potencialmente hepatotóxicas. Todos foram submetidos à avaliação clínica e análise de exames bioquímicos. A presença de EH (graus I, II e III) foi avaliada por ultrassonografia. Tomografia coronária foi realizada para determinar o escore de cálcio (EC) coronariano. Esse resultado foi transformado em percentil de acordo com idade e sexo, baseado em normograma específico existente na literatura.RESULTADOS: A amostra consistiu de 108 pacientes, a maioria do sexo feminino (71,2%) com idade média de 52,78 anos. Níveis reduzidos de HDL (mg/dL) e circunferência abdominal aumentada (cm) estiveram estatisticamente associados à EH (p < 0,05). Dentre os pacientes sem EH, 21,21% apresentavam ES acima do 50.o percentil. Já dentre os casos com EH moderada e grave, 91,66% estavam acima da mediana no EC. CONCLUSÃO: Colesterol HDL e circunferência abdominal elevada estiveram associados à EH. Por sua vez, a presença de EH e sua gravidade foram preditores de calcificação coronária mais acentuada na população estudada.

BACKGROUND AND OBJECTIVES: Metabolic syndrome(MS) is a predictor of cardiovascular mortality and events. Hepatic steatosis (HS), a common finding in MS, has been questioned as a possible marker of atherosclerosis in this population.The purpose of the present study is to evaluate the association of HS with coronary calcification in patients with MS. METHOD: Non-smokers from both genders, without known coronary disease and not using statins or potentially hepatotoxic medications were included. The patients were submitted to a clinical evaluation and biochemical analysis. The presence of HS (degrees I, II and III) was evaluated by abdominal ultrasound.Coronary tomography was completed for detection of the coronary calcium score (CS), and the result was transformed into percentile in accordance with age and gender, according to the standard nomogram. RESULTS: The sample consisted of 108 patients, with the majority being female (71.2%) with an average age of 52.78 years.Low HDL levels and greater abdominal circumference were statistically related to HS (p < 0.05). In the group without HS,21.21% had CS above the 50th percentile. By other side, among patients with moderate to severe EH, 91.66% were above the median on CS. CONCLUSION: Low HDL-cholesterol (mg/dL) and elevated abdominal circumference were associated with HS. In turn, the presence and amount of HS were predictors of a higher degree of coronary calcium.