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OBJECTIVE: Considering that misfit is a significant predictor of the clinical success of indirect restorations, the objective of this study was to evaluate the marginal and internal misfit of two computer-aided design and manufacturing (CAD/CAM) RMC ceramic materials used as occlusal veneers (OVs) of different thicknesses. METHODS AND MATERIALS: A CAD model of a mandibular first molar was obtained and OV preparations 0.5-, 1.0-, and 1.5-mm thick were modeled and milled in two different materials (n=10/group): resin nanoceramic (RNC) and polymer-infiltrated ceramic network (PICN). Using the same CAD model, tooth preparations were milled in fiber-reinforced epoxy resin (n=20/thickness). The marginal and internal misfit of the restorations was assessed by X-ray microtomography. The measurements of the marginal gap (MG) and absolute marginal discrepancy were performed in two locations on each slice, whereas internal gap (IG) measurements were performed at ten locations on each slice. The data obtained were analyzed using two-way analysis of variance and Tukey post-hoc tests (α=0.05). RESULTS: No significant effect was attributable to the material type or material-thickness interaction for the MG, absolute marginal discrepancy (AMD), or IG (p>0.05). However, the thickness significantly affected the IG of the restorations (p<0.05). CAD/CAM RNC and PICN systems presented similar MG and AMD for OVs 0.5-, 1.0-, and 1.5-mm thick. However, the IG varied between thicknesses.
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Cerámica , Diseño Asistido por Computadora , Microtomografía por Rayos X , Diente MolarRESUMEN
INTRODUCTION: With the emergence of blunt-tipped microcannulas, there is a hypothesis that these could cause less damage and reduce pain as compared to conventional sharp needles in eyelid surgery. The purpose is to determine whether an 18G blunt-tipped cannula can be better than a 26G needle. METHODS: This prospective, observer-blinded, randomized clinical trial was conducted from June 2017 to December 2018. Sixty-eight patients were randomized to receive local anesthesia injections for upper blepharoplasty. Infiltration was performed by using a 26-gauge sharp needle on one side and on the other side, infiltration was performed by using an 18-gauge stainless-steel blunt-tipped microcannula. A numeric rating scale (NRS) from 0 to 10 was used to blindly assess pain in patients receiving anesthesia injections with both needle types. Photographs of the eyelids of each patient were taken in five different periods and used by three blinded observers to identify bruise or ecchymoses. RESULTS: A total of 136 eyelid operations were performed. There was no statistically significant difference when both groups were compared; however, the average score of pain was higher in patients taking the infiltration through the needle (2.85 versus 2.50). Regarding the evaluation of bruising and ecchymoses, the results showed that, in the five periods evaluated, there was no statistical difference in bruising and ecchymosis in the eyelids when taking the infiltration through a sharp needle when compared with that of the eyelids taking infiltration through a (blunt-tipped) microcannula. CONCLUSION: The evaluation of the blunt-tipped microcannula showed a lower pain score mean than that obtained for the sharp needle (2.5 versus 2.85) (p > 0.05). There was no statistically significant difference in the bruising and ecchymosis courses.
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Anestesia Local/instrumentación , Blefaroplastia , Cánula/efectos adversos , Contusiones/prevención & control , Equimosis/prevención & control , Agujas/efectos adversos , Dolor Asociado a Procedimientos Médicos/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anestesia Local/métodos , Contusiones/diagnóstico , Contusiones/epidemiología , Contusiones/etiología , Método Doble Ciego , Equimosis/diagnóstico , Equimosis/epidemiología , Equimosis/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Asociado a Procedimientos Médicos/diagnóstico , Dolor Asociado a Procedimientos Médicos/epidemiología , Dolor Asociado a Procedimientos Médicos/etiología , Estudios ProspectivosRESUMEN
There are few long-lived radionuclides yielding high intensity gamma-rays emission with energies ranging from 100 keV to 500 keV that can be applied as radioactive gamma standard to calibrate HPGe detectors. Furthermore, this energy range represents the main emitted energies of the majority of radionuclides used in nuclear medicine. The Brazilian National Laboratory for Ionizing Radiation Metrology (LNMRI/IRD/CNEN) has attempted to identify radionuclides that have the potential to be used as a calibration source due to their long half-life as well as their emission spectrum. Hence, LNMRI promotes standardization studies of gamma-emitting radionuclides that meet these criteria on order to disseminate them. Thorium-229, with its well-defined energies and relatively high intensities, is one such candidate radionuclide for the energy and full-energy peak efficiency calibration of high-purity gamma spectrometers. Thorium-229 was standardized by the method of 4παß(LS)-γ(NaI(Tl)) live timed anticoincidence counting. The emission intensities of gamma-rays associated with the decay of 229Th have been determined by HPGe gamma ray spectrometry with accuracy and precision. The results are in agreement with current literature data.
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The probabilities of locating peaks with a high relative peak-area uncertainty were determined empirically with nine types of peak-location software used in laboratories engaged in gamma-ray spectrometry measurements. It was found that it is not possible to locate peaks with a probability of 0.95, when they have a relative peak-area uncertainty in excess of 50%. Locating peaks at these relatively high peak-area uncertainties with a probability greater than 0.95 is only possible in the library-driven mode, where the peak positions are supposed a-priori. The deficiencies of the library-driven mode and the possibilities to improve the probabilities of locating peaks are briefly discussed.
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We studied the ontogenetic growth of goat wethers (castrated male goats) of the Saanen and Swiss Alpine breeds based on a large range of intraspecific body mass (BM). The body parts and the chemical constituents of the empty body were described by the allometric function by using BM and the empty body mass (EBM) as the predictors for morphological traits and chemical composition, respectively. We fitted the allometric scaling function by applying the SAS NLMIXED procedure, but to evaluate assumptions regarding variances in morphological and compositional traits, we combined the scaling function with homoscedastic (MOD1), and the heteroscedastic exponential (MOD2) and power-of-the-mean (MOD3) variance functions. We also predicted the ontogenetic growth by using the traditional log-log transformation and back-transformed results into the arithmetic scale (MOD4). We obtained predictions from MOD4 in the arithmetic scale by a two-step process, and evaluated MOD1, MOD2 and MOD3 by a model selection framework, and compared MOD4 with MOD1, MOD2 and MOD3 based on goodness-of-fit measures. Based on information criteria for model selection, heterogeneous variance functions were more likely to describe 10 over 36 traits with a low level of model selection uncertainty. One trait was predicted by averaging the MOD1 and MOD2 variance functions; and nine traits were better described by averaging the MOD2 and MOD3 variance functions. The predictions for other 16 traits were averaged from MOD1, MOD2 and MOD3. However, MOD4 better described 11 traits according to the goodness-of-fit measures. Depending on the variable being analyzed, the body parts and the chemical amounts exhibited the three types of allometric behavior with respect to BM and EBM, that is, positive, negative and isometric ontogenetic growth. Reference BMs, that is, 20, 27, 35 and 45 kg, were used to compute the net protein and energy requirements based on the first derivative of the scaling function, and the results were presented in reference to the EBM and EBM0.75. Both the net protein and energy requirements scaled to EBM0.75 increased from 20 to 45 kg of BM.
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Cabras/crecimiento & desarrollo , Modelos Estadísticos , Algoritmos , Animales , Composición Corporal , Tamaño Corporal , Proteínas en la Dieta , Ingestión de Energía , Cabras/anatomía & histología , MasculinoRESUMEN
RESUMO A espécie Phaseolus lunatus L., conhecida popularmente como feijão-fava constitui uma das alternativas de renda e alimentação para a população da região Nordeste do Brasil. Um dos problemas enfrentados são as doenças que provocam grandes perdas na produção de sementes. O presente trabalho objetivou avaliar a eficiência dos óleos essenciais de copaíba, cravo-da-índia e manjericão na redução da incidência de fungos associados às sementes de feijão-fava, e sua interferência na qualidade fisiológica. Os tratamentos foram constituídos por óleos essenciais de copaíba, cravo-da-índia e manjericão nas concentrações de 0; 1; 1,5 e 2 mL. L-1 e fungicida (Captan®). Foram utilizadas 200 sementes por tratamento. Para análise da qualidade sanitária das sementes foi adotado o método de incubação em placas de Petri contendo dupla camada de papel-filtro umedecida com ADE, sob temperatura de 20 ±2 ºC, por 7 dias. A qualidade fisiológica das sementes foi determinada com base nos testes de germinação, emergência e vigor das sementes. Para o teste germinação foi empregado método de rolo de papel germitest e na emergência osemeio foi realizado em bandejas plásticas contendo areia lavada esterilizada, em condição de casa de vegetação, e após 9 dias da instalação foi determinado o vigor com base nos resultados de índice de velocidade de germinação e emergência; comprimento da parte aérea, raiz primária e plântula; e teor de massa seca da partes aérea, raízes e plântulas de feijão-fava. O delineamento experimental foi interiamente casualizados, em esquama de fatorial simples (3x4)+1 (óleos essenciais x concentrações + fungicida), com quatro repetições de 50 sementes. Os óleos essenciais de copaíba e manjericão reduziram consideravelmente o percentual de incidência dos fungos associados as sementes de feijão-fava. O óleo essencial de cravo-da-índia na concetração de 2 mL. L-1, reduziu a qualidade fisiológica das sementes de feijão-fava.
ABSTRACT The Phaseolus lunatus L. species, popularly known as lima bean, is one of the alternative sources of income and food for the population of Northeast Brazil. One of the problems is the diseases that cause great losses in seed production. This study evaluated the effectiveness of essential oils of copaiba, clove, and basil in reducing the incidence of fungi associated with lima bean seeds, as well as the effect on their physiological quality. The treatments consisted of essential oils of copaiba, clove, and basil at concentrations of 0; 1; 1.5; and 2 mL. L-1 and fungicide (Captan®). A total of 200 seeds were used per treatment. To analyze the sanitary quality of the seeds, the method used was incubation in petri dishes containing a double layer of filter paper moistened with distilled sterilized water at a temperature of 20 ± 2°C, for seven days. The physiological quality of the seeds was determined by testing their germination, emergence, and vigor. For the germination test, the method used was a roll of Germitest paper. For the emergence, the seeds were sown in plastic trays containing washed sterilized sand in greenhouse conditions. After nine days, the vigor was determined based on the results of germination and emergence speed rates; length of the aerial part, primary root, and seedling; and dry matter content of the aerial part, roots, and seedlings of the lima beans. The experimental design was completely randomized in a simple factorial arrangement (3x4)+1 (essential oils x concentrations + fungicide) with four replications of 50 seeds. The essential oils of copaiba and basil considerably reduced the percentage of incidence of the fungi associated with lima bean seeds. The essential clove oil at 2 mL. L-1 reduced the physiological quality of the lima bean seeds.
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Semillas/clasificación , Aceites Volátiles/análisis , Phaseolus/clasificación , Syzygium/clasificación , Hongos/clasificación , Fabaceae/clasificaciónRESUMEN
Radiation sources have being widely used in industrial applications, but their inappropriate use presents a large potential for hazards to human health and the environment. These hazards can be minimised by development of specific radiation protection rules and adequate procedures for the handling, use and storage of radiation sources, which should be established in a national normative framework. Recently, due to discovery of new oil and gas reservoirs on the Brazilian continental shelf, especially in deep water and the pre-salt layer, there has been a large and rapid increase in the use of radiation sources for well logging. Generic radiation protection regulations have been used for licensing the use of radiation sources for well logging, but these are not comprehensive or technically suitable for this purpose. Therefore it is necessary to establish specific Brazilian safety regulations for this purpose. In this work, an assessment is presented of the relevant radiation protection aspects of nuclear well logging not covered by generic regulations, with the aim of contributing to the future development of specific safety regulations for the licensing of radioactive facilities for oil and gas well logging in Brazil. The conclusions of this work relate to four areas, which include the specific requirements to control (1) radiation sources, (2) radiation survey meters and (3) access to radiation workplaces and (4) to control and identify the workers who are occupationally exposed.
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Gas Natural/análisis , Yacimiento de Petróleo y Gas/química , Petróleo/análisis , Traumatismos por Radiación/prevención & control , Monitoreo de Radiación/métodos , Protección Radiológica/métodos , Radioisótopos/análisis , Brasil , Humanos , Exposición Profesional/análisis , Exposición Profesional/prevención & control , Administración de la Seguridad/métodosRESUMEN
The National Laboratory for Metrology of Ionizing Radiation (LNMRI)/Brazil participated in the last (57)Co activity measurement comparison organized by IAEA, in 2008. This was made in order to realize primary standardization of this radionuclide and to reduce the measuring uncertainties in the laboratory. Additionally, one sample with 2.6g was taken from the IAEA master solution of (57)Co and was prepared to be used in the measurement of the radionuclide's half-life in an ionization chamber system. The (57)Co half-life was measured to be 271.82 (17) days.
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Radioisótopos de Cobalto/análisis , Radioisótopos de Cobalto/química , Radiometría/instrumentación , Radiometría/normas , Brasil , Semivida , Internacionalidad , Dosis de Radiación , Estándares de Referencia , Valores de ReferenciaRESUMEN
Stem cell-based therapies represent a promising therapy for myocardial infarction. Pre-clinical and clinical tests performed in the last 10 years indicate that several types of stem cells and their progenies reduce infarct size and improve cardiac contractile function. The mechanism is dependent on the type of cell and involves a combination of several factors, such as: (i) the formation of new blood vessels, (ii) the release of pro-survival, pro-angiogenic and anti-inflammatory factors (paracrine effect), and (iii) the functional contribution of cardiomyocytes. With the exception of cardiac progenitor cells and pluripotent stem cells (human embryonic stem cells and inducible pluripotent stem cells) that have the unquestioned ability to give rise to cardiomyocytes, the other stem cells, including bone-marrow stem cells and fetal stem cells, have none or very limited capacity to differentiate into contractile cells. For both cases, it is of the utmost importance to develop strategies to promote cell survival and in vivo engraftment as well as to unravel the therapeutic mechanism of stem cells. This review focuses on the recent developments of stem cells and on the use of biomaterials for efficiently stem cell delivery and tracking.
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Corazón/fisiología , Infarto del Miocardio/patología , Infarto del Miocardio/cirugía , Regeneración/fisiología , Trasplante de Células Madre/métodos , HumanosRESUMEN
To detect Cryptosporidium sp., Giardia sp. and Eimeria leuckarti in horses, fecal samples were collected from three different handling horse groups from the state of Rio de Janeiro, Brazil. Group A was composed of "Mangalarga Marchador" pure breed horses, Group B was formed by horses of a Military Corporation and Group C by stray horses captured by the Center of Zoonosis Control Paulo Dacorso Filho. A total of 396 fecal samples were collected, 212 samples from Group A, 154 samples from Group B and 30 from Group C. The material was submitted to the centrifugation - flotation technique and staining by the safranin-methylene blue technique and analyzed. Oocysts of Cryptosporidium sp. were identified in 0.75% of the samples (n=3); cysts of Giardia sp. in 0.5% (n=2) and oocysts of E. leuckarti in 0.5% (n=2). One case of E. leuckarti in group A and one of Cryptosporidium sp. in group B were observed. In group C were observed two cases of Cryptosporidium, two of Giardia and one of E. leuckarti,. Horses of group C were more parasitized by the three protozoans than animals from the other groups (p<0.01). It was possible to verify that factors related to the animals, like host individual susceptibility and sanitary factors may influence the occurrence of natural infections by gastrointestinal protozoans, although the age did not have influence. This study reports, for the first time, the occurrence of Cryptosporidium sp., Giardia sp. and E. leuckarti in equines of the State of Rio de Janeiro.
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Crianza de Animales Domésticos/métodos , Coccidiosis/veterinaria , Criptosporidiosis/veterinaria , Eimeria/aislamiento & purificación , Giardiasis/veterinaria , Enfermedades de los Caballos/epidemiología , Animales , Brasil/epidemiología , Coccidiosis/epidemiología , Criptosporidiosis/epidemiología , Heces/parasitología , Femenino , Giardiasis/epidemiología , Caballos , Higiene , Masculino , Oocistos , PrevalenciaRESUMEN
Interleukin (IL)-6 is an inflammatory mediator involved in bone resorption. G/C polymorphism at position -174 of the IL-6 gene has been reported to influence IL-6 expression, with the G allele associated with higher expression levels. The aims of this study were to investigate the expression of IL-6 as well as the incidence of IL-6 (-174) gene polymorphism and their correlation to the severity of periodontitis in Brazilians. Peripheral blood mononuclear cells were collected from 12 non-smoker individuals with periodontitis for evaluation of IL-6 expression using flow cytometry. We observed a positive correlation between the mean clinical attachment loss and intensity of expression of IL-6, in which the greater the attachment loss, the higher the expression of IL-6 (P=0 x 007, R2=0 x 52). Also, patients with severe periodontitis displayed a higher intensity of IL-6 expression compared to moderate periodontitis (P=0 x 04). To determine the occurrence of IL-6 gene polymorphism, DNA was obtained from oral swabs of 209 Brazilian individuals with and without periodontitis. Polymerase chain reaction, restriction endonuclease digestion and electrophoresis were performed, allowing for detection of the IL-6 (-174) polymorphism. We observed that non-smokers with moderate periodontitis (P=0 x 05) and control (P=0 x 04) groups displayed a higher incidence of the G genotype when compared to severe periodontitis. This suggests that the G genotype may represent a protective role in severity of periodontitis. Thus, the increased expression of IL-6 and IL-6 (-174) polymorphism are associated with periodontal disease severity in Brazilian individuals.
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Interleucina-6/sangre , Periodontitis/inmunología , Polimorfismo Genético , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Citometría de Flujo/métodos , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Interleucina-6/genética , Leucocitos Mononucleares/inmunología , Masculino , Persona de Mediana Edad , Periodontitis/genética , Índice de Severidad de la EnfermedadRESUMEN
Visits were made to six farms raising dairy goats located in the mountain region of the state of Rio de Janeiro, Brazil, seeking to identify parasitism by Giardia sp. and Cryptosporidium sp. During the visits, fecal samples were collected from approximately 10% of the stock of each property. A questionnaire was given to the keepers on each property to obtain data for epidemiological analysis. A total of 105 fecal samples was collected, 56 from adult animals (over 12 months of age) and 49 from juvenile animals (less than 12 months). The fecal material was processed and subjected to the centrifuge-flotation technique and to staining with safranine-methylene blue. Protozoans of the genus Cryptosporidium were found at two properties, where the hygiene conditions of the installations were considered average and the stalls were made of wood slats raised from the ground. A total of five (4.8%) of the samples was found to be positive for the presence of this protozoan, all from juvenile animals. Cysts of the genus Giardia were found at two properties. Of the 105 samples analyzed, the protozoan was detected in 15 (14.3%), all in juvenile animals, and animals in the age range of 1-3 months had significantly more infections. Age, sanitary condition of the stalls and stalls made of wood slats and raised from the ground, can be pointed out as possible risk factors for infection by Giardia sp. and Cryptosporidium sp. The study reports for the first time the occurrence of Cryptosporidium sp. and Giardia sp. in goats in the state of Rio de Janeiro.
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Criptosporidiosis/veterinaria , Cryptosporidium/aislamiento & purificación , Giardia/aislamiento & purificación , Giardiasis/veterinaria , Enfermedades de las Cabras/parasitología , Crianza de Animales Domésticos , Animales , Brasil/epidemiología , Criptosporidiosis/epidemiología , Criptosporidiosis/parasitología , Heces/parasitología , Femenino , Giardiasis/epidemiología , Giardiasis/parasitología , Enfermedades de las Cabras/epidemiología , Cabras , Recuento de Huevos de Parásitos/veterinariaRESUMEN
In order to compare natural infection by Cyptosporidium sp. and Giardia sp. in clinically healthy dogs living in two situations (animal shelter and household pets), we conducted 166 faecal exams using the technique of centrifugation-flotation in a sugar-saturated solution. Of the faecal samples, 94 came from shelter dogs and 72 from house pets. Eighty-two (49.4%) contained parasite eggs, cysts or oocysts. Of these, four (2.41%) contained Cryptosporidium sp. oocysts and 52 (31.33%) contained Giardia sp. cysts. There was no statistically significant difference between the origin of the dogs and Cryptosporidium sp. infection. Infection by Cryptosporidium sp. was not associated with the living conditions and sex. With respect to Giardia sp., we observed a statistically significant difference (p < 0.001) between the shelter dogs (45%) and the household pets 12.3%. There was no association of infection by Giardia sp. with age or sex.
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Criptosporidiosis/veterinaria , Cryptosporidium/aislamiento & purificación , Enfermedades de los Perros/parasitología , Giardia/aislamiento & purificación , Giardiasis/veterinaria , Factores de Edad , Animales , Animales Domésticos , Brasil/epidemiología , Criptosporidiosis/epidemiología , Criptosporidiosis/parasitología , Enfermedades de los Perros/epidemiología , Perros , Heces/parasitología , Femenino , Giardiasis/epidemiología , Giardiasis/parasitología , Masculino , Recuento de Huevos de Parásitos/veterinaria , Factores Sexuales , Población UrbanaRESUMEN
OBJECTIVE: To determine the usefulness of reagent strips in the evaluation of pleocytosis, cerebrospinal fluid glucose and protein levels for early and rapid diagnosis of meningitis in children. METHODS: We included cerebrospinal fluid samples of 164 children admitted to the outpatient clinic of Communicable Diseases of the General Pediatric Center (Fundação Hospitalar do Estado de Minas Gerais, CGP-FHEMIG) during the daytime hours from May of 1997 to May 1999, and who presented with clinical suspicion of meningitis. Patients ranged in age from one month to 12 years (median 12 months). Results from the cytological and biochemical assay (cellularity, cerebrospinal fluid glucose and protein levels) were obtained from 154 patients. These results were subsequently compared with the reaction of cerebrospinal fluid in reagent strips. RESULTS: The cytological and biochemical assay identified 43 cases of probable bacterial meningitis, 19 of probable viral meningitis, and 83 with no alterations. According to the reagent strips, there were 41 cases of probable bacterial meningitis, 2 of probable viral meningitis, and 71 with no alterations. By comparing the results of reagent strips and those of the cytological and biochemical assay, we obtained values for sensitivity, specificity, positive and negative predictive values, and accuracy (respectively 90.7; 98.1; 95.1; 96.4; and 96.1). Statistical analysis using McNemer test did not indicate significant differences between the two methods in the diagnosis of bacterial meningitis (P=0.68). Kappa statistics indicated a high level of agreement between the tests (P<0.0001). CONCLUSIONS: Our results suggest that reagent strips may be a useful additional resource in the diagnosis of bacterial meningitis, especially when it is difficult to collect a sufficient amount of cerebrospinal fluid or to indicate the initial treatment.
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Coronary angiography remains the only definitive diagnostic procedure to assess the severity and extension of coronary artery disease. We discuss some technical aspects and the place of angiography in the risk stratification of the coronary patient comparing conservative and invasive strategies. It is suggested that a progressively more important role will be played by the general practitioner regarding indication, interpretation and therapeutic decision, sharing responsibilities with the cardiologist and the patient. With increased facilities for coronary angiography and increased ad hoc angioplasties, observed at present, the GP should also be responsible for proper selection of the reference cardiologists and hospitals.
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Atención Ambulatoria , Angina de Pecho/diagnóstico por imagen , Angiografía Coronaria , Medios de Contraste , Angiografía Coronaria/métodos , Humanos , Derivación y Consulta , Medición de RiesgoRESUMEN
In patients less than 40 years of age, acute myocardial infarction (AMI) has special clinical and pathophysiologic characteristics. Its prevalence varies between 5 and 10%. In such patients, AMI associated with chronic cocaine abuse has a non-negligible prevalence of 6%. The purpose of this report is to describe the case of a 24-year old male patient with smoking habits and chronic abuse of cocaine and hallucinogenic drugs. This patient developed clinical, enzymatic and electrocardiographic criteria of anterior AMI, two hours after the ingestion of an LSD-like hallucinogenic drug. The coronary angiography revealed a critical stenosis of the medium segment of the left anterior descendent artery, and a pre-stenotic aneurysmatic dilatation. In order to determine the etiology of the aneurysm, various laboratory and histologic tests were performed. The results of these were normal. We review the pathophysiology, clinical manifestations and prognosis of cocaine-associated AMI.
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Cocaína , Infarto del Miocardio/etiología , Trastornos Relacionados con Opioides/complicaciones , Adulto , Enfermedad Crónica , Alucinógenos , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Factores de Riesgo , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
OBJECTIVE: To compare the mitral valvular area obtained by two-dimensional echocardiography (2DMVA) to that obtained by Doppler through pressure half-time, (T1/2P) method (DMVA) in patients submitted to open or closed commissurotomy. POPULATION: Data were obtained from 53 patients, 44 females and 9 males who ranged in age from 19 to 63 years (mean = 40.4 +/- 8) submitted to open commissurotomy (group A) or closed procedure (group F). The time from surgery to Echo ranged from 10 to 100 months (mean = 63 +/- 26). Ther were twenty one patients, in group A and 32 in group F. METHODS: All the patients underwent two-dimensional echocardiography and continuous-wave doppler, guided by image and sound, so that the maximum velocity was located, using a Diasonics DRF 300 machine equipped with a combined echo-Doppler 3.5 mHz transducer. The mitral valve was visualized in short axis view the 2D mitral valve area was measured as the planimetered area along the inner border of the smallest orifice, while scanning through the short axis. Continuous-wave Doppler recordings were performed at 50 mm/s. The pressure half-time was measured as the interval between maximum velocity and maximum velocity/1.4. The valvular area (DMVA) was obtained by the expression 220/T1/2p. Maximum velocity (VMax) of mitral flux and the prevalence of significant mitral regurgitation (> = 2) were also compared in groups A and F. The relationship between 2DMVA and DMVA were compared by simple linear regression analysis and the other parameters by the t test and by chi-squared analysis. RESULTS: 2DMVA in the total patients was 2.26 +/- 0.59 and the DMVA 2.31 +/- 0.76 (NS). There were no significant difference between groups A e F concerning: VMax = 162.48 +/- 28.15 and 150.09 +/- 30.08, DMVA = 2.34 +/- 0.75 and 2.29 +/- 0.76 respectively, and mitral regurgitation = 2 patients in both groups. The correlation between the Doppler and the 2D obtained areas was good in group A r = 0.76 SEE there were no correlation between these values in group F r = 0.33. CONCLUSIONS: We can conclude that the mitral valvular area obtained by two-dimensional echocardiography, correlates to the Doppler mitral valvular area in patients with prior open commissurotomy proving the complementary role of the two methods.
Asunto(s)
Ecocardiografía Doppler , Ecocardiografía , Válvula Mitral/diagnóstico por imagen , Adulto , Ecocardiografía/instrumentación , Ecocardiografía/estadística & datos numéricos , Ecocardiografía Doppler/instrumentación , Ecocardiografía Doppler/estadística & datos numéricos , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Periodo PosoperatorioRESUMEN
OBJECTIVE: To assess the prognosis of Unstable Angina according to its clinical presentation using Braunwald's Classification. DESIGN: Retrospective study of hospital admissions from January 1982 to September 1990. SETTING: Coronary Care Unit and a Cardiology Department of a Central Hospital. PATIENTS: There were 132 patients, 109 men and 23 women, with a mean age of 56 +/- 9 years, all submitted to cardiac catheterization at least 90 days after hospital admission followed up during 34.2 +/- 24.2 months. MATERIAL AND METHODS: Patients were divided in three groups according to the clinical presentation of Unstable Angina: Group A--Aggravated Chronic Angina and/or "De Novo" Angina; Group B--Angina at Rest but not in the last 48 hours, and Group C--Angina at Rest in the last 48 hours. Group A was also sub-divided, and the patients with Unstable Angina after myocardial infarction were excluded. The previous clinical profile was evaluated as well as the circumstances in which Unstable Angina occurred, need of Coronary Care Unit, angiographic findings and follow-up. RESULTS: Within the 132 patients, 86 were in the group A, (59 with Aggravated Angina and 27 with "De Novo" Angina), 11 in group B, and 35 in group C. The group with Aggravated Angina had higher incidence of previous myocardial infarction and bypass surgery (p < 0.01 and p = 0.05), compared to group with "De Novo" Angina and B, and also three vessels disease associated to ventricular dysfunction. "Culprit Lesion" appeared more frequently as eccentric type I in group A, and as concentric in group C. Revascularization procedures were performed in 95 patients (CABG in 66 and PTCA in 29) being respectively: 21 and 6 were urgent, 19 and 18 were elective and 26 and 5 were late procedures. CABG were more frequent in group A. There were 73 major cardiac events in 44 patients (8 deaths, 12 myocardial infarction and 53 new episodes of Unstable Angina), which were more frequent in group with Aggravated Angina and group C. The chance of patients with major cardiac events was in a 78 months follow-up, about 25% for group with "De Novo" Angina, 50% for patients with Aggravated Chronic Angina, and was greater than 75% in patients with Angina at Rest and episodes in the last 48 hours (p < 0.05)--Log-rank Test. The worse prognosis was seen in patients with Aggravated Chronic Angina, when a gathering of clinic patterns of Braunwald's classification were present. CONCLUSIONS: In summary, the group with Aggravated Angina and group C had more severe disease, required more urgent CABG and PTCA, and had also a higher incidence of cardiac events. The group with better prognosis was the group with "De Novo" Angina, which should be distinguished of the group with Aggravated Angina who was the worst prognosis.