Unraveling the rapid CO2 mineralization experiment using the Paraná flood basalts of South America.

CO2 capture and storage in geological reservoirs have the potential to significantly mitigate the effects of anthropogenic gas emissions on global climate. Here, we report the results of the first laboratory experiments of CO2 injection in continental flood basalts of South America. The results show that the analyzed basalts have a mineral assemblage, texture and composition that efficiently allows a fast carbonate precipitation that starts 72 h after injection. Based on the availability of calcium, chemical monitoring indicates an estimated CO2 storage of ~ 75%. The carbonate precipitation led to the precipitation of aragonite (75.9%), dolomite (19.6%), and calcite (4.6%).

Phenotypic Characterization of CD4+ T Lymphocytes in Periportal Fibrosis Secondary to Schistosomiasis.

Schistosomiasis is a parasitic disease that affects about 166 million people around the world. It is estimated that 5%-10% of individuals with schistosomiasis develop severe forms of the disease, which are characterized by pulmonary hypertension, ascites, periportal fibrosis, and other significant complications. The chronic phase of the disease is associated with a Th2 type immune response, but evidence also suggests there are roles for Th1 and Th17 in the development of severe disease. The aim of this study was to evaluate the CD4+ T lymphocyte profile of patients with different degrees of periportal fibrosis secondary to schistosomiasis. These individuals had been treated for schistosomiasis, but since they live in a S. mansoni endemic area, they are at risk of reinfection. They were evaluated in relation to the degree of periportal fibrosis and classified into three groups: without fibrosis or with incipient fibrosis (WF/IFNE), n=12, possible periportal fibrosis/periportal fibrosis, n=13, and advanced periportal fibrosis/advanced periportal fibrosis with portal hypertension, n=4. We observed in the group without fibrosis a balance between the low expression of Th2 cytokines and high expression of T reg cells. As has already been described in the literature, we found an increase of the Th2 cytokines IL-4, IL-5, and IL-13 in the group with periportal fibrosis. In addition, this group showed higher expression of IL-17 and IL-10 but lower IL-10/IL-13 ratio than patients in the WF/IFNE group. Cells from individuals who present any level of fibrosis expressed more TGF-ß compared to the WF/IFNE group and a positive correlation with left lobe enlargement and portal vein wall thickness. There was a negative correlation between IL-17 and the thickness of the portal vein wall, but more studies are necessary in order to explore the possible protective role of this cytokine. Despite the fibrosis group having presented a higher expression of pro-fibrotic molecules compared to WF/IFNE patients, it seems there is a regulation through IL-10 and T reg cells that is able to maintain the low morbidity of this group.

Speciation analysis of inorganic As and Sb in urban dust using slurry sampling and detection by fast sequential hydride generation atomic absorption spectrometry.

In this work, a methodology for chemical speciation analysis of inorganic As and Sb in urban dust using slurry sampling and detection by fast sequential hydride generation atomic absorption spectrometry is proposed. Doehlert design and desirability function were used to find the optimum conditions for hydride generation (1.0 mol L-1 HCl and 0.9% m v-1 NaBH4). The accuracy of the analytical method was evaluated by analysis of reference material fly ash (BCR 176R), addition and recovery tests for inorganic As species, and comparison of independent methods for Sb determination in urban dust samples. The determination of the total concentrations of As and Sb and their inorganic species presented good accuracy, between 80 ± 1 and 101 ± 6%. Precision was expressed as the relative standard deviation and was better than 4.7% (n = 3). The limit-of-quantification values were 0.23 and 1.03 mg kg-1 for As and Sb, respectively. The methodology was applied to eight samples of dust collected in an urban area of Salvador and Jaguaquara cities, Bahia, Northeast, Brazil, with an aerodynamic size lower than 38 µm. Concentrations of pentavalent inorganic species (iAs5+ and iSb5+) in relation to trivalent species (iAs3+ and iSb3+) were found in urban dust collected in the city of Salvador, which are regarded as more toxic for both elements. The enrichment factor and geoaccumulation index (Igeo) values showed that for some samples, the concentrations of iAs and iSb presented strong enrichment and, and regarding environment, strong to moderately polluted by iAs and iSb, with an indication of anthropogenic contributions. The occurrence of these inorganic constituents in the urban area of Salvador can be related with intense industrial activities and vehicular traffic.

Characterization of memory T cells in individuals resistant to Schistosoma mansoni infection.

Schistosomiasis affects about 240 million people worldwide and is estimated that about 700 million people live in areas at risk of infection. In the context of immune response associated with infection by Schistosoma mansoni, the role of memory T cells is not well understood. AIM: To evaluate the frequency of memory CD4+ and CD8+ T cells from individuals resistant and susceptible to Schistosoma mansoni infection. METHODS AND RESULTS: We selected individuals with low (resistant) and high (susceptible) parasite burden using databases generated during previous studies carried out in the same endemic area. The cell surface markers were performed using flow cytometry. In this study, the resistant individuals showed an increase in the CD4+ memory T-cell pool associated with an increase in the central memory cell (TCM) and a decrease in the effector memory cell (TEM ). Individuals susceptible to infection had higher frequencies of effector memory cells compared to resistant individuals. CONCLUSIONS: These data suggest that resistance to S mansoni infection may be associated with an increase in the number of CD4+ memory T cells and susceptibility to infection is associated with a decrease in the central memory cell as well as high proportions of effector memory cells.

Seasonality of airborne trace element sources in Aracaju, Northeastern, Brazil.

In this work the urban area of Aracaju city, located in the State of Sergipe, Northeastern Brazil was the site for simultaneous collection of suspended particles (TSP) and inhalable particulate matter (PM10) aiming an evaluation of the air quality parameters. Concentrations of Cd, Co, Cu, Fe, Mn, Ni, Pb and V in TSP and PM10 were determined by inductively coupled plasma mass spectrometry (ICP-MS). Iron was the most abundant element found in both particulate samples. Through chemometric tools, it was possible to point out that the contributions to the TSP and PM10 formation are similar, and strong correlations were observed between Fe-Mn (0.83) and Cd-Pb (0.93) in TSP, and Fe-Mn (0.90), Fe-Cu (0.81) and Cd-Pb (0.97) in PM10, an evidence that these species are from sources related mainly to soil resuspension and vehicular traffic. Enrichment factor (EF) and geoaccumulation index (Igeo) showed an influence of fossil fuel burning in the composition of TSP and PM10. Through principal component analysis (PCA) and hierarchical cluster analysis (HCA) it was observed particle size distribution groupings according to its aerodynamic size. Evaluation of the concentrations obtained for the collected samples according to the seasons (dry and rainy), indicated the influence of both, biogenic (resuspension of soil and marine aerosols) and anthropic (vehicle traffic and biomass burning) sources.

Sequential determination and chemical speciation analysis of inorganic As and Sb in airborne particulate matter collected in outdoor and indoor environments using slurry sampling and detection by HG AAS.

In this work, fast sequential determination and chemical speciation analysis of inorganic arsenic and antimony in airborne particulate matter collected in outdoor and indoor environments using slurry sampling and detection by hydride generation atomic absorption spectrometry (HG-AAS) is proposed. A Doehlert design was applied to optimise the hydride generation conditions of As and Sb for fast sequential determination in the same aliquot of particulate matter samples after preparation of the slurry. The limits of quantification (LoQ) obtained for As and Sb were 0.3 and 0.9 ng m-3, respectively. The accuracy of the analytical method was confirmed by analysis of the certified reference material of urban particulate matter (SRM NIST 1648a), presenting concordance with certified values of 92.7±7.7% for As and 91.2±9.5% for Sb. Precision was expressed as relative standard deviation (% RSD, n=3), with our results presenting values better than 3.4% and 4.2% for total inorganic As and Sb, respectively. For all analysed samples, total As concentrations and its inorganic species were below the LoQ of the analytical method (<0.3 ng m-3). However, the averages of total inorganic Sb concentrations in airborne particulate matter, collected as total suspended outdoor particles (TSPoutdoor), inhalable particulate matter (PM10), and total suspended indoor particles (TSPindoor), were 3.1±0.5, 2.4±0.6, and 2.6±0.4 ng m-3, respectively. Trivalent Sb (Sb3+) was the predominant inorganic species in all samples investigated, with mean percentages of 76%, 72%, and 73% in TSPoutdoor, PM10, and TSPindoor, respectively. The presence of Sb and its predominant inorganic form (Sb3+) can be attributed to vehicular traffic close to the sampled urban areas. Therefore, fast sequential determination of As and Sb and their inorganic species in particulate matter samples prepared as slurry by FS-HG-AAS is an efficient, accurate, and precise method and can be successfully applied to routine analysis.

Impaired immunoregulatory network of the CD4 T lymphocytes in refractory asthma.

BACKGROUND: The immunopathogenesis of severe asthma has been associated with an inefficient regulatory response. There are a few studies about the CD4 T cells profile among individuals with severe asthma refractory to treatment. OBJECTIVE: To evaluate the CD4 T lymphocyte profile from individuals with severe asthma according to their response to treatment, relating to their atopy status and age of asthma onset. METHODS: We evaluated nineteen individuals with severe asthma refractory to treatment (SAR), 21 with well-controlled or partly controlled severe asthma (CSA) and 23 with mild-to-moderate asthma (MMA). Lymphocytes were obtained from PBMC, and the frequency of expression of different molecules in this population was assessed using the flow cytometry. RESULTS: We observed the frequency of CD4+ IFN-γ+ T cells was higher in atopic individuals with SAR than with CSA. In addition, among the atopic and early-onset asthma (EOA), the frequency of CD4+ CTLA-4+ T cells was lower in the SAR group than the CSA group. In relation to non-atopic and late-onset asthma (LOA) phenotypes, we noted the frequency of CD4+ FoxP3+ T cells was lower in individuals with SAR than with CSA. We also observed among the LOA patients, the frequency of CD4+ TGF-ß+ T cells was decreased in SAR group than the in CSA group. CONCLUSION AND CLINICAL RELEVANCE: Our data suggest that refractoriness to treatment in asthma is associated with a lower expression of distinct regulatory molecules by CD4 T cells between those who are atopic and have EOA and those who are non-atopic and have LOA. Thus, these results may contribute to the identification of new regulatory strategies to treat asthma according to their phenotypes.

Susceptibility of dendritic cells from individuals with schistosomiasis to infection by Leishmania braziliensis.

Coinfection with leishmaniasis and schistosomiasis has been associated with increased time to healing of cutaneous lesions of leishmaniasis. The objective of this study was to evaluate the effect of Leishmania braziliensis infection on co-cultures of monocyte-derived dendritic cells (MoDCs) with autologous lymphocytes from patients with schistosomiasis and patients with cutaneous leishmaniasis. MoDCs were differentiated from peripheral blood monocytes, isolated by magnetic beads, infected with L. braziliensis, and co-cultured with autologous lymphocytes. Expression of HLA-DR, CD1a, CD83, CD80, CD86, CD40, and the IL-10 receptor (IL-10R) on MoDCs as well as CD28, CD40L, CD25, and CTLA-4 on lymphocytes were evaluated by flow cytometry. The production of the cytokines IL-10, TNF, IL-12p40, and IFN-γ were evaluated by sandwich ELISA of the culture supernatant. The infectivity evaluation was performed by light microscopy after concentration of cells by cytospin and Giemsa staining. It was observed that the frequency of MoDCs expressing CD83, CD80, and CD86 as well as the MFI of HLA-DR were smaller in the group of patients with schistosomiasis compared to the group of patients with leishmaniasis. On the other hand, the frequency of IL-10R on MoDCs was higher in patients with schistosomiasis than in patients with leishmaniasis. CD4+ and CD8+ T lymphocytes from patients with schistosomiasis presented a lower frequency of CD28 and a higher frequency of CTLA-4 compared to lymphocytes from patients with leishmaniasis. Levels of IL-10 were higher in the supernatants of co-cultures from individuals with schistosomiasis compared to those with leishmaniasis. However, levels of TNF, IL-12p40, and IFN-γ were lower in the group of individuals with schistosomiasis. Regarding the frequency of MoDCs infected by L. braziliensis after 72h in culture, it was observed that higher frequencies of cells from patients with schistosomiasis were infected compared to cells from patients with leishmaniasis. It was concluded that MoDCs from patients with schistosomiasis are more likely to be infected by L. braziliensis, possibly due to a lower degree of activation and a regulatory profile.

Characterisation and source identification of the total airborne particulate matter collected in an urban area of Aracaju, Northeast, Brazil.

In this work, studies using samples collected in an urban area of Aracaju city, Sergipe State, Northeast, Brazil revealed that soil dust in suspension was the main source of total airborne particulate matter (TAPM), followed by vehicular pollution. The concentration profiles for Cu, Fe, Mn, Ni, V and Ti were established for the collected TAPM samples. The concentrations of SO2 and smoke were also measured all along the 42 sampling days. Through multivariate data analysis of the results a correlation between Fe, Mn, Ni and Ti in the mineral composition of the particles was established, indicating soil dust in suspension as the main source of TAPM. The concentrations of Cu and smoke were found to be related to vehicular traffic, and the second largest source of TAPM. Enrichment factors (EF) were calculated for the studied elements, and only Cu was found to be enriched. The concentrations of the elements in TAPM were evaluated using the geoaccumulation index (Igeo), and Fe, Mn, Ni, V and Ti were found to derive from natural sources, in TAPM. However, approximately 55% of the samples did not presented Cu contamination (Igeo≤0), and the remaining 45% presented Cu concentrations levels that indicated between low to moderate (0

Bioaccessibility of bioactive compounds and antioxidant potential of juçara fruits (Euterpe edulis Martius) subjected to in vitro gastrointestinal digestion.

An in vitro method involving simulated gastrointestinal digestion was used to assess the bioaccessibility of fifteen minerals, twenty-two phenolic compounds and the antioxidant capacity in juçara fruit during seven ripening stages. For minerals and phenolics, respectively, initial contents were up to 1325.9 and 22.9mg100g-1, whereas after in vitro digestion, the maximum values were 556.7 and 14.43mg100g-1 (dry matter). Antioxidant capacity, determined by 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity (DPPH) and ferric reducing antioxidant power (FRAP), after in vitro digestion decreased 51-78% when compared to the crude extract. Bioaccessible fractions of quercetin, protocatechuic and p-coumaric acids presented positive and significant correlation with results of DPPH and FRAP. Furthermore, our study demonstrated that the ripening stages of juçara fruit influenced the bioaccessibility of compounds and antioxidant capacity, which presented higher levels in purple fruits collected 42-69days after the appearance of the red berries on bunches.

Schistosoma mansoni antigens alter activation markers and cytokine profile in lymphocytes of patients with asthma.

Asthma is a chronic disease characterized by airway inflammation, obstruction and hyperresponsiveness. Severe asthma affects a small proportion of subjects but results in most of the morbidity, costs and mortality associated with the disease. Studies have suggested that Schistosoma mansoni infection reduces the severity of asthma and prevent atopy. OBJECTIVE: We evaluated the ability of S. mansoni antigens, Sm29 and Sm29TSP-2 to modulate lymphocyte activation status in response to the allergen of the mite Dermatophagoides pteronyssinus (Der p1) in cell cultures of individuals with asthma. METHODS: Thirty four patients were enrolled in this study: seventeen patients with severe asthma (SA group), seventeen patients with mild asthma (MA group) and six controls with no asthma. Peripheral blood mononuclear cells (PBMC) were obtained and stimulated with Sm29 and Sm29TSP-2 in the presence or absence of Der p1. The expression of surface markers and cytokines on lymphocytes was evaluated by flow cytometry and the levels of IL-10 in the culture supernatant were determined by ELISA. RESULTS: The addition of Sm29 and Sm29TSP-2 antigens to PBMC cultures from both groups of subjects with asthma stimulated with Der p1 reduced the frequency of CD4+CD25low cells whereas and increased frequency of CD4+CD25high population was observed compared to unstimulated cultures. Moreover, cultures stimulated with Sm29TSP-2 showed a reduction in the frequency of T cells expressing CD69, IFN-γ, TNF and TGF-ß in the MA group and an increase in the frequency of CD4+TSLPR+ T cells in the SA group. The addition of Sm29 to the cultures reduced the frequency of CD4+CD69+ and CD4+IL-5+ T cells in all asthmatic groups, and reduced the frequency of CD4+ T cells expressing IL-13 in the MA group. The cultures stimulated with Sm29 and Sm29TSP-2 showed an increase in the level of IL-10 in the supernatants. CONCLUSION: These results suggest that the addition of Sm29 and Sm29TSP-2 to the cells cultures from subjects with asthma reduced cell activation markers and altered the cytokine production pattern in a way that can potentialy control the inflammatory response associated with asthma.

Investigation of chemical modifiers for the direct determination of arsenic in fish oil using high-resolution continuum source graphite furnace atomic absorption spectrometry.

High-resolution continuum source graphite furnace atomic absorption spectrometry (HR-CS GF AAS) has been applied for the development of a method for the determination of total As in fish oil samples using direct analysis. The method does not use any sample pretreatment, besides dilution with 1-propanole, in order to decrease the oil viscosity. The stability and sensitivity of As were evaluated using ruthenium and iridium as permanent chemical modifiers and palladium added in solution over the sample. The best results were obtained with ruthenium as the permanent modifier and palladium in solution added to samples and standard solutions. Under these conditions, aqueous standard solutions could be used for calibration for the fish oil samples diluted with 1-propanole. The pyrolysis and atomization temperatures were 1400 °C and 2300 °C, respectively, and the limit of detection and characteristic mass were 30 pg and 43 pg, respectively. Accuracy and precision of the method have been evaluated using microwave-assisted acid digestion of the samples with subsequent determination by HR-CS GF AAS and ICP-MS; the results were in agreement (95% confidence level) with those of the proposed method.

Assessment of the Halogen Content of Brazilian Inhalable Particulate Matter (PM10) Using High Resolution Molecular Absorption Spectrometry and Electrothermal Vaporization Inductively Coupled Plasma Mass Spectrometry, with Direct Solid Sample Analysis.

Halogens in the atmosphere play an important role in climate change and also represent a potential health hazard. However, quantification of halogens is not a trivial task, and methods that require minimum sample preparation are interesting alternatives. Hence, the aim of this work was to evaluate the feasibility of direct solid sample analysis using high-resolution continuum source molecular absorption spectrometry (HR-CS MAS) for F determination and electrothermal vaporization-inductively coupled plasma mass spectrometry (ETV-ICP-MS) for simultaneous Cl, Br, and I determination in airborne inhalable particulate matter (PM10) collected in the metropolitan area of Aracaju, Sergipe, Brazil. Analysis using HR-CS MAS was accomplished by monitoring the CaF molecule, which was generated at high temperatures in the graphite furnace after the addition of Ca. Analysis using ETV-ICP-MS was carried out using Ca as chemical modifier/aerosol carrier in order to avoid losses of Cl, Br, and I during the pyrolysis step, with concomitant use of Pd as a permanent modifier. The direct analysis approach resulted in LODs that were proven adequate for halogen determination in PM10, using either standard addition calibration or calibration against a certified reference material. The method allowed the quantification of the halogens in 14 PM10 samples collected in a northeastern coastal city in Brazil. The results demonstrated variations of halogen content according to meteorological conditions, particularly related to rainfall, humidity, and sunlight irradiation.

Avaliação da incapacidade laborativa nos pacientes portadores de cardiopatias congênitas / Employment incapacity assessment in patients with congenital heart diseases

A presente monografia tem como objeto descrever as principais cardiopatias congênitas encontradas na idade adulta, que são em número considerável e apresentam quadro clínico variável, e muitas vezes incapacitam estes pacientes para o trabalho, seja de forma temporária ou definitiva...

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 6 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 6 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% 6 2% vs. 87% 6 17%; P = 0.015), residual gradients

lower (0.4 6 1.4 vs. 5.9 6 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% 6 172% vs. 190% 6 104%; P = 0.007), and CoA diameter larger (16.9 6 2.9 vs. 12.9 6 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for

G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 6 2.9 vs. 14.6 6 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood

pressure was similar in both groups at follow-up (126 6 12/81 6 11 for G1 vs. 120 6 15/80 6 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic

wall abnormalities.

Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults.

More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 +/- 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 +/- 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% +/- 2% vs. 87% +/- 17%; P = 0.015), residual gradients lower (0.4 +/- 1.4 vs. 5.9 +/- 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% +/- 172% vs. 190% +/- 104%; P = 0.007), and CoA diameter larger (16.9 +/- 2.9 vs. 12.9 +/- 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 +/- 2.9 vs. 14.6 +/- 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood pressure was similar in both groups at follow-up (126 +/- 12/81 +/- 11 for G1 vs. 120 +/- 15/80 +/- 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic wall abnormalities.

Surgical treatment of coarctation of the aorta using trapezoidal aortoplasty.

OBJECTIVE: Trapezoidal aortoplasty is a technical variant of end-to-end anastomosis, which, based on elements of geometry, aims at increasing the diameter of the aorta at the level of the suture, therefore reducing the occurrence of residual or recurrent pressure gradients in the short and long run. METHODS: After resecting the coarcted area and ductal tissue, 3 trapezoids are confected in each aortic stump, which, when confronted, create a suture line with a sinusoidal aspect (zigzag). Thirty-three patients underwent surgery with this technique, 22 (66.7%) males, with ages ranging from 3 months to 36 years (mean of 9.84 +/- 9.69). RESULTS: No immediate or late deaths occurred. Follow-up ranged from 1.1 to 7.6 years (mean of 3.6 +/- 3.4). Most patients became asymptomatic with normal blood pressure levels, enabling the discontinuation of antihypertensive therapy (P<0.0001). A significant reduction in the pressure gradients was observed on Doppler echocardiography and during cardiac catheterization (P<0.001). The analysis of the images of aortography showed good anatomical continuity in the region of the anastomosis, and the morphometric study of the aorta revealed the beneficial effects of the technique indicated by the increase in the caliber of the aorta in the distal segment of the arch, isthmus, and descending portion. CONCLUSION: Trapezoidal aortoplasty showed satisfactory clinical results that allow its application in all cases indicated for end-to-end anastomosis.

Tratamento cirúrgico da coarctação de aorta pela aortoplastia trapezoidal / Surgical treatment of coarctation of the aorta using trapezoidal aortoplasty

OBJETIVO: A aortoplastia trapezoidal é uma variante técnica da anastomose término-terminal que, amparada em elementos da geometria, objetiva aumentar o diâmetro da aorta ao nível da sutura reduzida e, consequentemente, a manutenção de gradientes pressóricos residuais ou recorrentes indesejáveis a curto e a longo prazo. MÉTODOS: Após a ressecção da área coarctada e tecido ductal, são confeccionados em cada coto aórtico 3 trapezóides que, ao serem confrontados, criam linha de sutura com aspecto sinusoidal (zigue-zague). Foram operados por esta técnica 33 pacientes, a maioria homens, com idades variando de 3 meses a 36 anos (m 9,5 ± 9,7). RESULTADOS: Não ocorreu mortalidade imediata ou tardia e o tempo de evolução a longo prazo foi de 1,1 a 7,6 anos (m 3,6 ± 3,4). A maioria dos pacientes ficou assintomática com níveis normais de pressão arterial, possibilitando a descontinuação da terapêutica antihipertensiva (p<0,0001). Constatou-se importante redução dos gradientes pressóricos observados ao ecodopplercardiograma e ao cateterismo cardíaco (p<0,001). A análise das imagens das aortografias mostrou boa continuidade anatômica na região da anastomose e o estudo morfométrico da aorta revelou efeitos benéficos do método traduzidos pelo aumento do calibre da aorta no segmento distal do arco, istmo e porção descendente. CONCLUSÃO: A aortoplastia trapezoidal mostrou resultados clínicos satisfatórios que autorizam sua aplicação em todos os casos de anastomose término-terminal indicados.

Consequences of the prolonged waiting time for patient candidates for heart surgery.

OBJECTIVE: To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery. METHODS: From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases. RESULTS: The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery. CONCLUSION: Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.