[Coronary sinus atrial septal defect, ventricular septal defect and absence of left superior vena cava]. / Comunicação interatrial do tipo seio coronário, comunicação interventricular e ausência de veia cava superior esquerda.

We report a rare case of a 21 month old child with a coronary sinus atrial septal defect associated with perimembranous ventricular septal defect and no left superior vena cava. The diagnosis was made by transthoracic echocardiogram and confirmed by angiography. The patient was operated on uneventfully, both defects were closed with bovine pericardial patches and the flow from the coronary veins was directed towards the left atrium. An echocardiogram revealed complete closure of both defects.

[Infective endocarditis in children and adolescents]. / Endocardite infecciosa na infância e adolescência.

PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.

[Phako-small port]. / Faco "smallport".

The smallport system is a new technology that brings to surgeons who begin in phacoemulsification more advantages and control in surgery, more security and less time required for learning. The authors show the differences (advantages and disadvantages) between standard systems and the endocapsular "smallport". In nuclei up to grade 3 hardness we have good results with low phaco power (5-10%) and higher linear aspiration (200 mmHg) causing minimal loss of endothelial cells and quick visual rehabilitation.

Meniere's syndrome and otitis media.

We here present a clinical study of 37 patients with Meniere's syndrome. Meniere's syndrome can occur subsequent to and in some cases simultaneously with chronic otitis media. When otitis media which has occurred many years earlier in childhood becomes inactive, leading to sequelae of Meniere's later in life, full-blown Meniere's symptom-complex with vertigo tends to occur; whereas when active chronic otitis media accompanies Meniere's, cochlear Meniere's syndrome tends to predominate. Endolymphatic hydrops is described in pathological cases of labyrinthitis and in 11 human temporal bone cases where there is evidence of chronic otitis media in the absence of visible labyrinthitis. A discussion of pathogenic factors includes considerations of quantity of endolymph due to hypodevelopment of the endolymphatic duct and sac related to mastoid hypocellularity and otomastoiditis in childhood and to other endolymphatic malabsorptions and also considerations of endolymph quality which can influence endolymph production as well as absorption.

Meniere's disease and the peak audiogram.

Pure tone audiograms of 300 patients with Meniere's disease and 400 patients without Meniere's disease were compared for prevalence of a high-frequency peak configuration. Prevalence rate of 42% for a peak audiogram was observed in ears diagnosed with Meniere's disease compared with 6% for patients with cochlear hearing loss not attributed to Meniere's disease, and 7% for normal hearing patients. Prevalence of the peak audiogram in patients with Meniere's disease was significantly greater than either of the patient groups without Meniere's disease. Prevalence of peak audiogram was affected by duration and bilaterality of Meniere's disease, but not by the degree of hearing loss. A classification system is proposed for describing the peak audiogram based on the severity of the peak configuration and the degree of hearing loss.