Persistent left fifth aortic arch with pentalogy of Fallot.

Congenital double-lumen aortic arch resulting from persistence of the fifth aortic arterial arch (PFAA) is a rare congenital anomaly. It appears as a vascular structure running inferior and parallel to the "real" aortic arch from the innominate artery to the left subclavian artery. We report a case of persistent fifth aortic arch (systemic-to-systemic arterial connection) with pentalogy of Fallot in a patient who underwent successful intracardiac repair with a transannular patch with very proximal aortic cannulation for cardiopulmonary bypass (CPB).

Perfusion CT Imaging Follows Clinical Severity in Left Hemispheric Strokes.

OBJECTIVE: The purpose of this study was to assess how imaging findings on admission perfusion CT (PCT) and follow-up noncontrast CT (NCT), and their changes over time, correlate with clinical scores of stroke severity measured on admission, at discharge and at 6-month follow-up. METHODS: Fifty-two patients with suspected hemispheric acute ischemic stroke underwent a PCT within the first 24 h of symptom onset and a follow-up NCT of the brain between 24 h and 3 months after the initial stroke CT study. NIH Stroke Scale (NIHSS) scores were recorded for each patient at admission, discharge and 6 months; modified Rankin scores were determined at discharge and 6 months. Baseline PCT and follow-up NCT were analyzed quantitatively (volume of ischemic/infarcted tissue) and semiquantitatively (anatomical grading score derived from the Alberta Stroke Program Early CT Score). The correlation between imaging volumes/scores and clinical scores was assessed. Analysis was performed for all patients considered together and separately for those with right and left hemispheric strokes. RESULTS: Significant correlations were found between clinical scores and both quantitative and semiquantitative imaging. The volume of the acute PCT mean transit time lesion showed best correlation with admission NIHSS scores (R2 = 0.61, p < 0.001). This association was significantly better for left hemispheric strokes (R(2) = 0.80, p < 0.001) than for right hemispheric strokes (R2 = 0.39, p = 0.131). Correlation between imaging and NIHSS scores was better than correlation between imaging and modified Rankin scores (p = 0.047). The correlation with discharge clinical scores was better than that with 6-month clinical scores (p = 0.012). CONCLUSIONS: Baseline PCT and follow-up NCT volumes predict stroke severity at baseline, discharge and, to a lesser extent, 6 months. The correlation is stronger for left-sided infarctions. This finding supports the use of PCT as a surrogate stroke outcome measure.

[Micronuclei research the esophageal mucosa and its relationship with risk factors with cancer of the esophagus]. / Pesquisa de micronúcleos na mucosa esofágica e sua relação com fatores de risco ao câncer de esôfago.

PURPOSE: To demonstrate the frequency of micronucleus in esophageal mucous cells of smokers, consumers of alcoholic beverages and "maté" drinkers. METHODS: Material collected from the midlle esophagus in 250 consecutive patients submitted to upper digestive endoscopy was stained with acridine orange and the cytologist determined the number of micronuclei vizualized per each 500 cells examined. RESULTS: The frequency of micronucleated cells did not vary significantly (p > 0.05) when the following variables were considered: sex, place of residence (rural or urban), type of care (outpatient or inpatient), ingestion of alcohol. For two variables, smoking and "maté" consumption, there were significant differences in the frequency of micronuclei in the categories exposed and formerly exposed in relation to never exposed. CONCLUSION: A higher frequency of micronucleus in the esophageal mucous in smoking and "maté" drinkers was evidenced by this study.

[Risk factors related to esophageal cancer in Rio Grande do Sul, Brazil]. / Fatores de risco relacionados ao câncer de esôfago no Rio Grande do Sul.

BACKGROUND: Rio Grande do Sul, a State in southern Brazil, shows high mortality rates for esophageal cancer. Important geographical variations suggest external factors in the etiology. OBJECTIVE: The relationship between smoking, alcohol and "mate" to esophageal cancer. METHOD: 55 patients with esophageal cancer were interviewed, soon after the endoscopy, about risk factors; 110 patients who did not showed esophageal tumor in the endoscopy were the controls. RESULTS: Among the patients with esophageal cancer there were more farmer-workers (OD 3.3; 95% CI 0.9-11.2), father with antecedent cancer (OD 6.9; 95% CI 1.9-25.6), smoking and ex-smoking (OD 2.5; 95% CI 1.1-5.9), drinkers and ex- of alcohol (OD 5.3; 95% CI 2.6-11.0), drinkers and ex- of "mate" (OD 3.6; 95% CI 1.3-9.8). Others variables more frequent in the cases were: smoking for > 20 years; kind of alcohol (spirits), drinking alcohol every day, drinking "mate" every day and adding salt to food. CONCLUSIONS: Smoking, alcohol, "mate", farmer-workers and antecedent of father with cancer were significantly more frequent in the cases of esophageal cancer than in the controls.

Optimal brain perfusion CT coverage in patients with acute middle cerebral artery stroke.

BACKGROUND AND PURPOSE: PCT has emerged as an alternative to MR imaging for the assessment of patients with suspected acute stroke. However, 1 disadvantage of PCT is its limited anatomic coverage, which may impact the characterization of hemispheric ischemic strokes. The purpose of this study was to determine the optimal brain CT coverage required to accurately estimate the size of the infarct core relative to the MCA territory and the infarct-penumbra mismatch, by using a criterion standard of these parameters measured on PCT with 80-mm z-axis coverage. MATERIALS AND METHODS: Fifty-one patients with acute ischemic hemispheric stroke underwent PCT scanning (2 boluses, total coverage of 80 mm, 16 x 5 mm sections) within the first 24 hours of symptom onset and a follow-up NCCT of the brain between 3 days and 3 months after the initial stroke CT study. The volumes of PCT infarct and penumbra for each possible extent of z-axis coverage derived from the individual PCT sections were recorded (beginning with 5 mm of z-axis coverage above the orbits and then increasing the coverage in 5-mm increments in the z-axis up to 80 mm above the orbits). The infarct-penumbra mismatch and the size of the infarction relative to the MCA territory were calculated for each extent of z-axis coverage. Using the 80-mm z-axis coverage as the criterion standard, we calculated the accuracy of the values of the relative PCT infarct size and mismatch that were obtained by using more limited z-axis coverage. The impact of different levels of PCT z-axis coverage on the eligibility for reperfusion treatment was assessed. RESULTS: On the admission PCT, by using 80-mm of z-axis coverage, the mean perfusion infarct core volume was 45.9 +/- 44.0 cm(3) (range, 0-170 cm(3)) and the mean penumbra volume was 64.5 +/- 64.4 cm(3) (range, 0-226 cm(3)). The mean perfusion infarct core/MCA territory ratio was 19.6% +/- 16.2% (range, 0.1%-56%). The penumbra / (infarct + penumbra) ratio was 68.6% +/- 23.6% (range, 16.4%-100%). The final infarct volume on follow-up NCCT was 115.4 +/- 157.3 cm(3) (range, 1.79-647.4 cm(3)). The minimal z-axis PCT coverage required to obtain values similar to those obtained with 80-mm z-axis coverage was 75 mm for a mismatch of 0.5, fifty millimeters for a mismatch of 0.2, and 55 mm for a size of PCT infarct relative to the MCA territory. CONCLUSIONS: Seventy-five millimeters is the minimal PCT coverage required to use PCT as a tool to select patients with acute stroke for reperfusion therapy by using a mismatch of 0.5. A z-axis coverage of 50 mm was sufficient for a mismatch of 0.2; and 55 mm, for the size of PCT infarct relative to MCA territory (one-third or more).

The triple rule-out for acute ischemic stroke: imaging the brain, carotid arteries, aorta, and heart.

BACKGROUND AND PURPOSE: Ischemic stroke is commonly embolic, either from carotid atherosclerosis or from cardiac origin. These potential sources of emboli need to be investigated to accurately prescribe secondary stroke prevention. Moreover, the mortality in ischemic stroke patients due to ischemic heart disease is greater than that of age-matched controls, thus making evaluation for coronary artery disease important in this patient population. The purpose of this study was to evaluate the image quality of a comprehensive CTA protocol in patients with acute stroke that expands the standard CTA coverage to include all 4 chambers of the heart and the coronary arteries. MATERIALS AND METHODS: One hundred twenty patients consecutively admitted to the emergency department with suspected cerebrovascular ischemia undergoing standard-of-care CTA were prospectively enrolled in our study. We used an original tailored acquisition protocol using a 64-section CT scanner, consisting of a dual-phase intravenous injection of iodinated contrast and saline flush, in conjunction with a dual-phase CT acquisition, ascending from the top of the aortic arch to the vertex of the head, then descending from the top of the aortic arch to the diaphragm. No beta blockers were administered. The image quality, attenuation, and CNRs of the carotid, aortic, vertebral, and coronary arteries were assessed. RESULTS: Carotid, aorta, and vertebral artery image quality was 100% diagnostic (rated good or excellent) in all patients. Coronary artery image quality was diagnostic in 58% of RCA segments, 73% of LAD segments, and 63% of LCX segments. When we considered proximal segments only, the diagnostic quality rose to 71% in the RCA, 83% in the LAD, and 74% in the LCX. CONCLUSIONS: Our stroke protocol achieved excellent opacification of the left heart chambers, the cervical arteries, and each coronary artery, in addition to adequate carotid and coronary artery image quality.

Intestinal metaplasia in the distal esophagus and correlation with symptoms of gastroesophageal reflux disease.

Barrett's esophagus is a metaplastic condition that occurs in patients with gastroesophageal reflux disease (GERD) and its importance lies in its potential to develop adenocarcinoma of the esophagus. The diagnosis of Barrett's esophagus is based on finding of intestinal metaplasia of at least 3 cm of the distal esophagus. The diagnosis of intestinal metaplasia of less than 3 cm of the distal esophagus is controversial, regarding implications with GERD, adenocarcinoma, and Helicobacter pylori. The aims of the study were to determine the prevalence of intestinal metaplasia in the distal esophagus in patients with short segments of esophageal columnar-appearing mucosa (less than 3 cm), diagnosed endoscopically, in two groups of patients, with and without symptoms of GERD. In total, 97 patients were examined, with endoscopic finding of esophageal columnar-appearing mucosa less than 3 cm. From the total, 52 patients had symptoms of GERD and 45 patients were without these symptoms. These patients were subjected to distal esophageal biopsies obtained immediately below the epithelial transition. The biopsies were stained with hematoxylin-eosin and alcian blue at pH 2.5. Urease test for H. pylori detection in two fragments of gastric antrum was carried out. The presence of intestinal metaplasia in the distal esophagus was diagnosed in 16 (30.8%) patients in the GERD group and 12 (26.7%) patients without GERD symptoms. No statistical differences were observed (P = 0.82; 95% CI: 0.61-2.17). The variables sex, mean age and positivity for H. pylori did not show statistical differences. This study diagnosed high prevalence of intestinal metaplasia in the distal esophagus with columnar-appearing mucosa, less than 3 cm, with no statistical differences in the two groups studied with and without GERD symptoms.

Pesquisa de micronúcleos na mucosa esofágica e sua relaçäo com fatores de risco ao câncer de esôfago / Research of micronuclei in the esophageal mucosa and its relationship with risk factors to esophagus cancer

Micronúcleos sao fragmentos de DNA nao incorporados ao núcleo na divisao celular e que apresentam relaçao com agentes genotóxicos (mutagênicos ou clastogênicos). Os micronúcleos podem ser detectados nas células esfoliadas dos tecidos. OBJETIVO: Determinar a freqüência de micronúcleos na mucosa esofágica, relacionando com determinados hábitos. PACIENTES E MÉTODOS: Em pacientes submetidos à endoscopia digestiva alta e sem evidências de anormalidades esofágicas, foram colhidos materiais através de escovado do esôfago médio, para pesquisa de micronúcleos. Após à endoscopia, os pacientes foram questionados sobre seus hábitos. RESULTADOS: A freqüência de micronúcleos nao mostrou diferenças significativas (p > 0,05) em relaçao ao sexo, local de residência (rural ou urbana), tipo de atendimento (ambulatorial ou hospitalizado), ingestao de álcool. Nas variáveis fumo e mate houve diferenças significativas entre as categorias expostos e ex-expostos em relaçao à categoria nunca expostos. CONCLUSAO: A freqüência de micronúcleos na mucosa esofágica foi maior nos pacientes fumantes e bebedores de mate

Fatores de risco relacionados ao câncer de esôfago no Rio Grande do Sul / Risk factors fo esophageal cancer in Rio Grande do Sul, Brazil

Objetivo. O Rio Grande do Sul apresenta significativos coeficientes de mortalidade ao câncer de esôfago, com diferenças importantes nas microregioes, sugerindo a açao de fatores de riscos externos. Este estudo tem como objetivo mostrar a relaçao do câncer de esôfago com o hábito de fumar, ingerir álcool e mate. Casuística e Metologia. Foram entrevistados 55 pacientes com câncer de esôfago e 110 pacientes controles, sem evidências de tumor à endoscopia. Resultados. Nao foram observadas diferenças em relaçao ao sexo e idade entre casos e controles (p>0,05). Entre os casos foram verificados mais freqüentemente a presença de indivíduos cuja profissao estava ligada à atividade agrícola (RC 3,3; 95 por cento IC 0,9-11,2), pai com antecedente de câncer (RC 6,9; 95 por cento IC 1,9-25,6), fumantes e ex-fumantes (RC 2,5; 95 por cento IC 1,1-5,9), tomadores e ex-tomadores de bebidas alcoólicas (RC 5,3; 95 por cento IC 2,6-11,0), tomadores e ex-tomadores de mate (RC 3,6; 95 por cento IC 1,3-9,8). Outras variáveis mais freqüentes entre os casos de câncer de esôfago: fumantes > 20 anos, entre os tipos de álcool o uso de cachaça, ingestao de álcool diariamente, ingestao de mate diariamente e o hábito de adicionar sal nos alimentos. Conclusoes. Fumo, álcool, mate, agricultores e antecedentes de pai com câncer foram significativamente mais freqüentes entre os casos de câncer de esôfago em relaçao aos controles. Mate foi significativo, independente da quantidade ingerida/dia.