Leiomyoma of the Vulva: Case Report.

BACKGROUND: Leiomyoma of the vulva is rare, accounting for only 0.03% of all gynecological tumors, and it is seldom seen in teenagers. CASE: We describe a case of vulvar leiomyoma in a 14-year-old girl who presented a 10 × 10 cm solid tumor in the right hemivulva without other complaints. SUMMARY AND CONCLUSION: Differential diagnosis includes Bartholin cysts, abscesses, fibromas, and other solid lesions. Although rare, vaginal leiomyoma must be remembered and included as a differential diagnosis for solid lesions in the vagina.

Translation and adaptation of the physical activity enjoyment scale (PACES) in a sample of Portuguese athletes, invariance across genders nature sports and swimming / Tradução e adaptação do physical activity enjoyment scale (PACES) numa amostra de atletas portuguesas, invariância entre géneros, desporto de natureza e natação

Abstract The aim of this study was to translate and validate of the Physical Activity Enjoyment Scale (PACES) from Mullen et al. version in Portuguese athletes, invariance across genders and nature sports and swimming, as well as, external validity, through the Portuguese version of BRSQ.Athletes (n=1032; 273 nature sports, 759 swimming) with an average age of 18,95 ± 6,59 years participated in this study. Confirmatory factor analysis (maximum likelihood), multigroup analysis (measurement invariance) and correlation analysis were used for data analyzed. Results supported the suitability of the models (one factor which eight items) showing an adequate fit to the data in each sample (general:χ2=181,96, p=<0,01, df=20, SRMR=0,04, NNFI=0,94, CFI=0,96, RMSEA=0,07, RMSEA 90% IC=0,06-0,08; male:χ2=113,27, p=<0,01, df=20, SRMR=0,04, NNFI=0,95, CFI=0,97, RMSEA=0,07, RMSEA 90% IC=0,06-0,08; female: χ2=67,59, p=<0,01, df=20, SRMR=0,03, NNFI=0,94, CFI=0,96, RMSEA=0,07, RMSEA 90% IC=0,06-0,09; nature sports: χ2=42,32, p=0,02, df=20, SRMR=0,037, NNFI=0,96, CFI=0,98, RMSEA=0,06, RMSEA 90% IC=0,04-0,08; swimming: χ2=130,14, p=<0,01, df=20, SRMR=0,04, NNFI=0,94, CFI=0,96, RMSEA=0,07, RMSEA 90% IC=0,06-0,08), as well as, were invariant across genders and nature sports and swimming (∆CFI<0,01). Enjoyment was, on the one hand, found to be positively and significantly correlated with identified regulation (r=0,82), integrated regulation (r=0,62) and intrinsic motivation (r=0,90). On the other, it was negatively and significantly correlated with amotivation (r=-0,25) and external and introjected regulation (r=-0,42; -0,38), respectively. Those findings allow concluding that PACES can be used to measure enjoyment in the future studies, thus filling an existing gap to date.

Resumo O objetivo deste estudo foi a tradução e validação do Physical Activity Enjoyment Scale, a partir da versão de Mullen et al., numa amostra de atletas portugueses e a invariância entre gêneros, desportos de natureza e natação, bem como, comprovar critérios de validade externa através da versão portuguesa do BRSQ. Participaram neste estudo 1032 atletas (273 desporto natureza; 759 natação), com uma média de 18,95 ± 6,59 anos de idade. Os dados foram analisados através de análise fatorial confirmatória (método da máxima verosimilhança), análise multigupos (invariância entre grupos) e análise correlacional. Os resultados suportam a adequação dos modelos (1 fator, oito itens), para cada uma das amostras (geral. χ2=181,96, p=<0,01, df=20, SRMR=0,04, NNFI=0,94, CFI=0,96, RMSEA=0,07, RMSEA 90% IC=0,06-0,08; masculino: x2=113,27, p=<0,01, df=20, SRMR=0,035,NNFI=0,95, CFI=0,97, RMSEA=0,07, RMSEA 90%IC=0,06-0,08;feminino: χ2=67,59,p=<0,01, df=20, SRMR=0,03,NNFI=0,94, CFI=0,96, RMSEA=0,07, RMSEA90% IC=0,06-0,09; desporto de natureza: χ2=42,32, p=0,02, df=20, SRMR=0,037, NNFI=0,96, CFI=0,98, RMSEA=0,06, RMSEA90%IC=0,04-0,08; natação:χ2=130,14,p=<0,001, df=20, SRMR=0,04, NNFI=0,943, CFI=0,.96, RMSEA=0,07, RMSEA 90% IC=0,06-0,08), bem como, revelou ser invariante em função dos gêneros e das modalidades (∆CFI<0,01). O divertimento correlacionou-se positivamente com regulação identificada (r=0,82), regulação integrada (r=0,62) e motivação intrínseca (r=0,90), e negativamente com a amotivação (r=-0,25), regulação externa (r=-0,42) e regulação introjetada (r=-0,38). Estes resultados permitem-nos afirmar que a tradução e adaptação do PACES, pode ser utilizada com elevado grau de validade e fiabilidade na avaliação do divertimento em futuros estudos, suprimindo uma lacuna existente.

Seguimento de 12 meses de pacientes complexos tratados com stentsfarmacológicos liberadores de everolimus XIENCE V® na prática diária – resultados do registro brasileiro BRAVO / Twelve-month follow-up of complex patients treated with the Xience V™ everolimus drug-eluting stents in daily practice – results of the BRAVO Brazilian Registry

O stent liberador de everolimus XIENCE V® é um stent farmacológico de nova geração que incorpora uma plataforma de cromo-cobalto de baixo perfil (81 m) e um polímero de elevada biocompatibilidade (fluoropolímero), o qual carreia e controla a liberação do fármaco everolimus. Estudos recentes demonstram segurança e eficácia sustentadas do dispositivo XIENCE V® no tratamento de populações da prática clínica. Nosso objetivo foi reportar resultados clínicos de 12 meses do protocolo brasileiro BRAVO. Métodos: O registro BRAVO foi um estudo prospectivo, não randomizado, de braço único, multicêntrico (25centros), que avaliou os resultados clínicos tardios de 535 pacientes minimamente selecionados, tratados com o stent farmacológico XIENCE V®.Resultados: Cerca de 40% dos pacientes tinham diabetes, 25% infarto agudo do miocárdio prévio e 42% apresentaram-se com síndrome coronária aguda. A maioria das lesões (69%) era de elevada complexidade(ACC/AHA tipo B2/C). As médias da extensão e do diâmetro nominais dos stents foram, respectivamente, 19,9 ± 5,3 mm e 3,0 ± 0,4 mm. Os sucessos angiográfico e de procedimento foram de 99,7 e 98%, respectivamente. Aos 12 meses, a taxa cumulativa de eventos cardíacos adversos maiores, disponível em 100% dos pacientes, foi de 5,6% (morte cardíaca: 1,3%; infarto agudo do miocárdio: 3,0%; revascularização da lesão-alvo: 2,2%). Já a trombose de stent ocorreu em cinco pacientes (0,9%), sendo reportada apenas uma ocorrência entre 6 e 12 meses. Conclusões: O stent farmacológico XIENCE V® demonstrou segurança e eficácia sustentadas ao final de 12meses no tratamento de lesões coronárias complexas em pacientes da prática diária...

The Xience VTM everolimus-eluting stents is a new generation drug-eluting stent (DES)that incorporates a low profile cobalt-chromium platform (81 m) and a highly biocompatible polymer(fluoropolymer), which carries and controls the release of everolimus. Recent studies have demonstrated sustained safety and efficacy of the Xience VTM in the treatment of real-world populations. Our aim was to report the clinical results of 12 months of the BRAVO Brazilian protocol. Methods: The BRAVO Registry was a prospective, non-randomized, single-arm, multicenter (25 centers) study that evaluated the late clinical results of 535 minimally selected patients treated with the drug eluting stent Xience VTM in Brazilian daily practice. Results: Overall, 40% of patients had diabetes, 25% prior myocardial infarction, and 42% presented with acute coronary artery syndrome. The majority of lesions (69%) was highly complex (ACC/AHA type B2 or C).The mean length and the nominal stent diameter were 19.9 ± 5.3 mm and 3.0 ± 0.4 mm, respectively.The angiographic and procedural successes were 99.7 and 98%, respectively. At 12 months, the cumulative rate of major adverse cardiac events, available in 100% of patients, was 5.6% (cardiac death: 1.3%; acute myocardial infarction: 3.0%; revascularization of the target lesion: 2.2%). Stent thrombosis occurred in 5 patients (0,9%), and only 1 case was reported between 6 and 12 months. Conclusions: The drug-eluting stent Xience V™ demonstrated sustained safety and efficacy up to 12 months in the treatment of complex coronary lesions in patients from daily practice...

Lack of association between plasma myeloperoxidase levels and angiographic severity of coronary artery disease in patients with acute coronary syndrome.

OBJECTIVE: To evaluate the association between plasma myeloperoxidase (MPO) levels and angiographic severity of coronary atherosclerotic lesions in patients with non-ST elevation acute coronary syndrome (ACS). DESIGN AND METHODS: This cross-sectional study examined high-risk ACS patients who underwent coronary angiography within 72 h of the onset of symptoms by measuring their plasma MPO levels after sheath insertion. Gensini score was used to evaluate angiographic severity of coronary artery disease. RESULTS: A total of 48 patients were included in the study. Median MPO levels and Gensini scores were 6.9 ng/mL (4.4-73.5 ng/mL) and 10 (0-87.5), respectively. Spearman's correlation coefficient did not show a significant association between MPO levels and Gensini scores (r (s) = 0.2; p = 0.177). There was no correlation between MPO and age, hypertension, diabetes, leukocyte count, troponin I, CK-MB ≥ 2 × ULN (upper limit of normal), TIMI risk score ≥ 4 and Gensini score in the multivariate analysis. CONCLUSION: Our findings indicate that MPO expression is not associated with anatomical severity of coronary lesions in ACS.

Computerized procedure for analyzing hand kinematics with a peg-moving task (Sarah-Pegworks).

This article describes Sarah-Pegworks, a computerized procedure for analyzing hand kinematics based on the peg-moving task. The procedure, developed in Visual Basic 6 programming language, includes (1) processing raw data from an infrared motion-tracking system, (2) identifying movement components, and (3) analyzing and presenting hand kinematic information in numerical and graphic outputs. Fifty-five normal adults set the parameters relative to filtering and movement identification. A case was presented to illustrate the clinical value of this procedure.

Outpatient evaluation of vision and ocular motricity in 123 children with cerebral palsy.

PURPOSE: Children with cerebral palsy (CP) may present varied ophthalmological problems. Paradoxically, however, investigation of visual function and possible related disorders is not routinely conducted in this population during medical consultations. METHOD: This paper proposes a simple, practical guide for assessing vision and ocular motricity in children with CP. One-hundred and twenty-three patients (mean age: 8.4 years +/- 2.3) from the Sarah Network of Rehabilitation Hospitals (Brasilia, Rio de Janeiro and São Luis units) were studied. Various parameters were investigated (smooth pursuit movements, strabismus, visual acuity, visual field, visuospatial neglect and nystagmus) using the following assessment tools: adapted smooth pursuit test for ocular motricity; Snellen test for visual acuity; confrontation method for visual field; cancellation test (star test) for visual neglect; and cover test for strabismus. Nystagmus was assessed based on patient observation. RESULTS: Eighty-one children completed all the evaluations. Among these, 38 (47%) had no visual problems (hemiplegia 60.5%; diplegia 41.4%; triplegia 12.5%; mixed tetraplegic 33.3%); 23 had difficulties in one of the tested items; and 20 had problems in two or more areas of vision. CONCLUSIONS: Visual and oculomotor tests are of significant importance in children with CP and provide relevant information for creating a rehabilitation programme aimed at the individual as a whole.

Hand skill assessment with a reduced version of the Peg Moving Task (PMT-5) in children: normative data and application in children with cerebral palsy.

This paper proposes a simple method of hand skill assessment in children that can be useful in clinical practice. A reduced 5-hole version of Annett's Peg Moving Task was used to quantify hand skill bilaterally in 435 normally developing preschool and school-children, and adolescents aged 3-18 years from Brazil. The cross-cultural validity of the normative data obtained in Brazil was verified in 157 school-children aged 6-11 years from France. An application in 76 children with cerebral palsy (hemiplegia 21, diplegia 34, triplegia 6, mixed type 15) showed very important variability of the deficits in hand function within each subtype of cerebral palsy (CP). Hand deficits were more severe in children in special schools than in children in regular schools within each CP subtype. A qualitative analysis showed which difficulties during the execution of the task were specific to children with CP and which were also observed in normally developing children.

Influência da curva de aprendizado no sucesso e na ocorrência de complicações associadas aos procedimentos pela via radial / Influence of the learning curve on the success and occurrence of complications associated with transradial procedures

Fundamentos: A via de acesso transradial é uma técnica empregada mais recentemente na realização de procedimentos percutâneos coronários (diagnósticos e terapêuticos), sendo que apresenta várias vantagens em relação ao acesso femoral. Apesar disto, o acesso radial tem sido empregado de rotina apenas em uma minoria dos laboratórios de hemodinâmica de nosso país. Objetivo: Determinar a influência da curva de aprendizado sobre o índice de sucesso e a incidência de complicações associadas à realização tanto de procedimentos diagnósticos quanto terapêuticos pela via radial. Método: Foram analisados 3.500 pacientes consecutivos submetidos a procedimentos pela via radial, no período de abril de 2000 a junho de 2003. Foram excluídos desta análise pacientes com teste de Allen anormal e em programa de hemodiálise. O efeito da curva de aprendizado sobre os índices de sucesso e ocorrência de complicações foi avaliado comparando-se os resultados obtidos nos primeiros 500 pacientes (Grupo I) com os observados nos restantes 3000 pacientes (Grupo II). Resultados: Não houve diferença entre os grupos no que diz respeito ao sexo, à idade e ao tipo de procedimento realizado (diagnóstico ou terapêutico). A taxa de sucesso foi significativamente superior (98,1% contra 95,2%, p<0,01) e a ocorrência de complicações associadas ao sítio de acesso vascular significativamente menor no Grupo II (2,4% contra 6,1%, p<0,01). Adicionalmente, foi observado aumento progressivo dos índices de sucesso do procedimento com o incremento da experiência. Desta forma, o sucesso na realização do procedimento pela via radial nos primeiros 50, 100, 500 e 1.000 casos foi de, respectivamente, 88%, 94%, 97 e 98%. Conclusão: A técnica radial está associada a uma curva de aprendizado longa, que excede os primeiros quinhentos pacientes, sendo que a incidência de sucesso aumenta e a ocorrência de complicações diminui, de maneira significativa, com o aumento do número de casos.

Background: The transradial approach is a more recent technique employed to perform diagnostic and therapeutic coronary procedures, which offers many advantages when compared to the femoral approach. Nevertheless, the radial access is routinely utilized in only a few catheterization laboratories in our country. Objective: To determine the influence of the learning curve on the success rate and incidence of complications associated with performing diagnostic and therapeutic procedures using the radial approach. Methods: We analyzed 3,500 consecutive patients submitted to transradial procedures from April, 2000 through June, 2003. Patients with an abnormal Allen test, absent radial pulse, and those undergoing hemodialysis were excluded from this analysis. The effect of the learning curve on the success rate and on the occurrence of complications was evaluated by comparing the results obtained in the first 500 patients (Group I) to the results achieved in the remaining3,000 patients (Group II). Results: There were no differences identified between the groups in regard to gender, age and type of procedure performed (diagnostic catheterization or percutaneous intervention). The success rate was significantly higher (98.1% versus 95.2%, p<0.01) and the incidence of complications related to the vascular access site significantly smaller (2.4% versus 6.1%, p<0.01) in Group II. Additionally, a progressive increase in the success rate was observed with the greater experience using the technique. Therefore, the success rates in performing the procedure through the radial approach in the first 50, 100, 500 and 1,000 cases were, respectively, 88%, 94%, 97% and 98%. Conclusions: The transradial approach is associated with a long learning curve that exceeds the first 500 cases. The incidence of success increases and the occurrence of complications decreases significantly with the increase of the caseload.

Role of probucol in inhibiting intimal hyperplasia after coronary stent implantation: a randomized study.

BACKGROUND: Oxygen-free radicals can stimulate smooth muscle cell proliferation and may therefore be involved in the genesis of in-stent restenosis. Thus, treatment with probucol, a potent antioxidant agent that has been shown to reduce restenosis after balloon angioplasty, may be an effective strategy to prevent intimal hyperplasia after stenting. METHODS: In a prospective double-blind study, 59 patients submitted to coronary stent implantation were randomly assigned to treatment with either probucol (1 g/d) or placebo, starting two weeks before the procedure and continued for 6 months. The primary end point was the intimal hyperplasia volume at 6 months measured by intravascular ultrasound (IVUS) imaging. RESULTS: Of the 59 randomized patients, 54 underwent successful stent implantation, completed the follow-up period, and underwent repeat angiography, 6.1 +/- 1.1 months after the procedure. Volumetric IVUS analysis revealed similar intimal hyperplasia volumes (403 +/- 26.7 mm3 for probucol vs 44.8 +/- 28.3 mm3 for placebo) and percent volume obstruction of the lumen (30.4% +/- 14.5% for probucol versus 30.7% +/- 17.2% for placebo) in both groups. In addition, quantitative coronary angiography showed no differences in late loss (1.0 +/- 0.8 mm vs 1.1 +/- 0.8 mm), loss index (0.5 +/- 0.4 for both groups), or angiographic restenosis rates (19.4% vs 18.5%) between the probucol and placebo groups, despite the observation of significant changes in the lipid profile and in the plasma antioxidant defenses in patients receiving probucol. CONCLUSIONS: Treatment with the antioxidant probucol failed to reduce neointimal formation after coronary stent implantation as assessed by IVUS volumetric analysis.

Uso de stents no tratamento da coarctação da aorta / Stents use in aorta coactation treatment

A correção cirúrgica sempre foi a terapêutica de escolha para a coarctação da aorta, uma das cardiopatias congênitas mais frequentes. Como uma forma de tratamento menos invasiva, a aortoplastia com balão surgiu como alterntiva à cirurgia mas não atingiu ampla aceitação devido aos índices de reestenose secundária ao recolhimento vascular e discussões sobre possíveis lesões à parede vascular, resultando em formação de aneurismas. Para lidar com esses problemas, os stents endovasculares foram adicionados às possibilidades terapêuticas desta má formação. Os resultados a curto e médio prazo são encorajadores, com baixas taxas de reestenose e complicações. Neste artigo os autores revisam as principais evidências atuais de implante de stent para a coarctação da aorta apresentam sua própia experiência e discutem as futuras possibilidades nesta área.

Intervençoes percutâneas para revascularização do miocárdio no Brasil em 1996 e 1997 comparadas as do biênio 1992 e 1993. Relatório do registro CENIC (Central Nacional de Intervenoes Cardiovasculares) / Percutaneous myocardial revascularization procedures in Brazil in 1996-1997 compared to the 1992-1993 period. A report of the National Registry--National Center for Cardiovascular Interventions (CENIC)

PURPOSE: To report the results of percutaneous coronary interventions, in Brazil, in the years 1996-97, comparing them to those of 1992-93. METHODS: Data were collected in a standard form and the 1996-97 results were compared to those of 1992-93. RESULTS: The current Registry received data from 79effective members of the SBHCI in 127 hospitals, including 22,025 patients, 60.67of whom underwent PTCA, 36.57stent implantation, 2.3PTRA, 0.06DCA and 0.4laser angioplasty. Balloon angioplasty was the most frequent procedure in 1996-97, but its overall rate fell from 6.75to 55.8(p = 0.0001) concomitantly, there was a 35relative increase in the use of stents from 1992-93 to 1996-97. The success rate of the later period was higher (89.7vs 92.8, p = 0.000001), with lower residual stenosis (22vs 19, p = 0.001). Besides, there were lower major complications rates: acute myocardial infarction (2.5vs 1.2, p = 0.002) and death (1.8vs 1.4, p = 0.0003). CONCLUSION: The procedures most often carried out in both periods were balloon angioplasty (60.67) and implantation of stents (36.57); the success rate high, abrupt closure rate was low (1.5). These favorable results corroborate the high standards of the Brazilian Interventional Cardiology.

Influência do quadro clínico nos resultados imediatos e tardios após aterectomia rotacional / Influence of the Clinical Presentation in Acute and Long-Term Results After Rotational Atherectomy

PURPOSE: To analyse the influence of unstable coronary syndromes (UCS) in the early and late prognosis after rotational atherectomy (RA). METHODS: We treated 236 patients with RA between Aug/1992 and May/1996. Patients were divided into two groups: A) stable coronary syndromes 120 (51) patients; B) UCS: 116 (49) patients. Definitions: 1) procedure success (PS)--lesion success in all locations were RA use was attempted, without a major complication; 2) late coronary events (LCE)--angina, MI, additional revascularization or death. RESULTS: There was a significant predominance of age > 70 (A = 14x B = 24, p = 0.03) in B and previous MI (A = 32x B = 11, p = 0.0001) in A. Other characteristics were similar in both groups, including complex lesions (type B2/C), which were observed in 77A stenosis and 80B lesions. PS was 95in A and 92in B (p = NS). In-hospital major complications were observed in 2.5A and 4.3B patients, (p = NS). One patient died in each group. A and B patients had similar time of follow-up. LCE occurred in 25A and 39B patients (p = 0.002). Recurrence of angina (36x 23; p = 0.01) and target lesion revascularization (29x 18; p = 0.03) were also more frequently required in B cases. CONCLUSION: This study suggests that UCS (group A) does not implicate in worse acute results after RA. However, UCS patients present greater incidence of late coronary events, particularly recurrence of angina and target-lesion revascularization.

Papel do endotélio na regulaçäo celular e no remodelamento vascular: implicaçöes na reestenose pós-angioplastia coronária / Role of the endothelium in the regulation of cell proliferation and vascular remodeling: implications for restenosis after coronary angioplasty

A reestenose representa a maior limitaçäo a longo prazo da angioplastia coronária. O endotélio vascular, além de desempenhar importante papel na regulaçäo do tônus vasomotor arterial, também é o principal mediador de dois processo biológicos extremamente importantes na gênese da reestenose coronária: a proliferaçäo das células musculares lisas e o remodelamento vascular. Além de sintetizar fatores estimuladores e inibidores do crescimento celular, o endolélio ainda é o responsável pela manuntençäo da trombo-resistência, impedindo a ativaçäo das plaquetas, outra importante fonte de mitogenos. O remodelamento vascular e um processo biológico atuante na aterosclerose e evidências recentes indicam que ele é um fator na determinaçäo di surgimento ou näo da reestenose. O endotélio também parece ser o mediador primário do desenvolvimento de alteraçöes estruturais da parede do vaso em resposta a fatores hemodinâmicos. Esses achado säo extremamente úteis para o melhor entendimento da patogenes da reestenose e , além disso, podem ter importantes implicaçöes no desenvolvimento de estratégias que visem o controle dessa complicaçäo da angioplastia coronária.

Angioplastia primaria en el infarto agudo de miocardio. Resultados en 601 pacientes / Primary angioplasty in acute myocardial infarction. Results in 601 patients

Los autores relatan la experiencia acumulada de 11 años y 6 meses con el empleo de la angioplastia primaria (ATC) para el tratamiento del infarto agudo de miocardio en 601 pacientes. La edad media de los pacientes tratados era 58,7 años y 109 de ellos (18 por ciento) tenían edad igual o superior a 70 años. El intervalo medio entre el inicio de los síntomas y la realización de la ATC fue de 4 horas y 20 minutos (1-24 horas) y 173 pacientes (29 por ciento) fueron reperfundidos con intervalo superior a 6 horas. Fueron tratados 42 pacientes en shock cardiogénico. El infarto agudo de miocardio era de pared anterior en 277 pacientes (46 por ciento) y 306 pacientes (51 por ciento) presentaban patología multiarterial. Se obtuvo éxito primario en 531 pacientes (88 por ciento) con disminución de la estenosis residual de 98 ñ 2 por ciento para 25 ñ 10 por ciento (p< 0,001), con flujo TIMI 3 en 518 pacientes (86 por ciento). Se constató reinfarto en 38 pacientes (6,3 por ciento) y la mortalidad hospitalaria ocurrió en 45 casos (7,4 por ciento), siendo 2,5 por ciento en los casos con éxito y en ausencia de shock cardiogénico. En este subgrupo particular la mortalidad fue de 56 por ciento (36 por ciento en los casos con éxito). Previamente al alta hospitalaria 318 pacientes fueron reestudiados, constatándose reoclusión de la arteria relacionada al infarto agudo de miocardio en 29 pacientes (9,1 por ciento). La fracción de eyección se elevó de 43 por ciento a 49 por ciento en los casos en que la arteria relacionada al infarto agudo de miocardio permanecía permeable al alta (p<0,001). Los autores concluyen que la angioplastia primaria cursa con elevada tasa de éxito, baja mortalidad y produce efectiva recuperación de la fracción de eyección izquierda gracias al mantenimiento de la permeabilidad arterial en 91 por ciento de los casos

Angioplastia coronária em pacientes com lesoes reestenóticas. Caracterização do perfil clínico e angiográfico, evolução hospitalar e implicaçoes para seleção de pacientes / Coronary angioplasty in patients with restenotic lesions. clinical and angiographic profile, In-hospital outcome and implications for patient selection

PURPOSE--To define the clinical and angiographic profile of patients undergoing to a 2nd or a 3rd coronary angioplaty (PTCA) for the treatment of restenosis, and assess the safety and efficacy of redilatation. METHODS--Patients submitted to PTCA for a 1st (1stRE) or a 2nd (2ndRE) restenosis, from Jan/1980 through Dec/1993, were retrospectively identified, and compared to those undergoing to PTCA for de novo lesions (DN). RESULTS--A total of 5,736 underwent to dilatation of primary lesions, 610 of a 1stRE, and 64 of a 2ndRE. Patients with restenotic lesions had a higher prevalence of diabetes, smoking, history of prior infarction (1stRE e 2ndRE) and hyperlipidemia (2ndRE) as compared with primary lesions (p < 0.05). Besides patients with a 2ndRE had a higher incidence of left ventricular dysfunction, as compared to those with DN or a 1stRE (31.3 with EF < 45 in group 2ndRE, vs 19.8 and 23.1 in groups 1stRE and DN, respectively, p < 0.05). Primary success, infarct rate and mortality were similar in all groups, but emergency bypass surgery was significantly higher in the DN (2.1 vs 0.8 in 1stRE and 0 in 2ndRE, p < 0.05). CONCLUSION--Restenosis can be effectively treated by redilatation. Patients with clinical and angiographic features predisposing to further recurrence can be better treated with other interventions (i.e., coronary stents, bypass surgery).

Objetivo - Definir o perfil clínico e angiográfico dos pacientes submetidos à angioplastia coronária para tratar a 1ª ou 2ª recidiva e determinar os resultados dessa redilatação. Métodos -Identificar, retrospectivamente, os pacientes submetidos a uma 2g (1 gRE) ou 3ê (2-aRE) angioplastia para tratar reestenoses, entre jan/80 e dez/ 93, comparando-os com os submetidos à dilatação de lesões primárias (DN). Resultados - Um total de 5.736 haviam se submetido à dilatação de uma lesão primária, 610 de uma 1ª reestenose e 64 de uma 2ª reestenose. Pacientes com lesões reestenóticas apresentavam incidência significantemente maior de diabetes, tabagismo, história prévia de infarto (1ªRE e 2ªRE) e dislipidemia (2ªRE), que aqueles com lesões primárias (p<0,05). Além disso, os submetidos à 2ª recidiva apresentavam uma incidência significantemente maior de disfunção ventricular esquerda que os com 1ª reestenose ou lesões primárias (31,3 % com fração de ejeção <45% no grupo 2ªRE vs 19,8% no grupo 1ª RE e 23,1% no grupo DN, p<0,05). Os índices de sucesso, infarto e morte foram semelhantes nos 3 grupos; porém, a freqüência de cirurgia de emergência foi significantemente maior no grupo com lesões primárias (2,1% vs 0,8% no grupo 1ªRE e 0% no grupo 2ªRE, p<0,05). Conclusão - Pacientes com reestenose pós-angioplastia coronária podem ser tratados com segurança com nova dilatação. Determinados portadores de características clínicas e angiográficas predisponentes a novas recidivas possivelmen te se beneficiem mais se tratados com outras modalidades de revascularização do miocárdio

Oclusão aguda pós-angioplastia coronária. Manuseio precoce e evolução tardia / Acute Closure After Coronary Angioplasty. Management and Follow-Up

PURPOSE--Assess the efficacy of the different strategies employed in the management of acute closure and verify the late prognosis of patients who develop this complication. METHODS--From january 1987, through December 1990, 2315 consecutive patients underwent percutaneous transluminal coronary angioplasty (PTCA) in our Institution. We analyzed 100 patients who had had acute closure of the dilated vessel determining the total incidence of myocardial infarction and death, the effectiveness of the different treatment strategies and clinical and angiographic predictors of poor in-hospital outcome. Late follow-up was obtained in the hospital survivors. RESULTS--The incidence of acute myocardial infarction in the group of 100 patients was 57; death occurred in 12of the patients. Forty-one individuals were referred to emergency bypass surgery, 35 received clinical treatment and 24 underwent redilatation of the vessel. Those managed clinically had a higher incidence of myocardial infarction compared to the ones who underwent either redilatation or surgery (74.3versus 50and 48.8). The in-hospital mortality rate was significantly higher in patients with left ventricular ejection fraction < 45(44.4, p < 0.001) and in procedures involving the left anterior descending artery (20, p < 0.05); patients undergoing repeat dilatation had the lower death rate (4.2versus 8.6in the clinical group and 17.1in the surgical group). Late follow-up was obtained in 65 of 88 hospital survivors (mean follow-up = 17 months). Patients who underwent repeat dilatation were significantly less symptomatic in the follow-up than those who received medical therapy during the acute phase (89versus 60.9of patients without symptoms respectively, p < 0.05). Patients who were referred to surgery had also a tendency towards having less symptoms (87.5of asymptomatic patients in the late follow-up) although the difference was not statistically significant (0.01 > p > 0.05). CONCLUSION--Acute coronary occlusion is a serious complication of angioplasty and is associated with high rates of major complications (myocardial infarction, death). Low left ventricular ejection fraction and PTCA involving the left anterior descending are predictors of higher in-hospital mortality in patients with acute closure. Late outcome is less favourable in patients submitted to clinical treatment in the acute phase.

Complicaçöes atuais do cateterismo cardíaco: análise de 1000 pacientes / Current complications of heart catheterization: analysis of 1000 cases

Avaliar o imnpacto das novas técnicas de cateterismo cardíaco sobre a incidência de complicaçöes. Mil pacientes consecutivos submetidos a cateterismo cardíaco no período de agosto a dezembro de 1989 (739 cateterismos diagnósticos e 261 terapêuticos) acompanhados até a alta hospitalar. As complicaçöes foram classificadas segundo o tipo e a gravidade e correlacionadas à técnica do procedimento e à fraçäo de ejeçäo do ventrículo esquerdo (FEVE). Em 77,7% dos pacientes näo houve complicaçöes. Nos restantes (22,3%) as complicaçöes foramÑ leves (11,2%), moderadas (7,3%) e severas (3,8%). Entre as últimas, ocorreram ,5% de intercorrências vasculares graves, 0,1% de perfuraçäo cardíaca necessitando de cirurgia de emergência, 1,4% de arritmias severas, 0,4% de infarto agudo do miocárdio, 0,3% de edema agudo de pulmäo e 0,5% de mortalidade. Os estudos hemodinâmicos permanecem com índice relativamente baixo de complicaçöes, apesar do crescente número de procedimentos intervencionistas e da maior gravidade dos pacientes estudados