Left ventricular noncompaction in a Para athlete.

The left ventricular noncompaction is a congenital cardiomyopathy characterized by the presence of abnormal trabeculations in the left ventricle. The present study describes the case of a 14-year-old female Para athlete, who plays goalball. She was asymptomatic, with history of congenital nystagmus and mild visual impairment, who presented nonspecific electrocardiographic abnormalities during pre-competition screening. Cardiac magnetic resonance imaging showed left ventricular non-compaction (non-compacted to compacted layer ratio equal to 2.5) and mild biventricular systolic dysfunction. Initially, the patient was excluded from sports participation and clinical follow-up was performed every three months. Patient remained asymptomatic during the one-year follow-up, with no history of unexplained syncope, marked impairment of systolic function or significant ventricular arrhythmias at the exercise stress test. Finally, she was released for competitive goalball participation and clinical follow-up was continued every 6 months. There is no consensus regarding the eligibility criteria for sports participation in cases of left ventricular non-compaction. Thus, it is prudent to individualize the decision regarding practice of sports, as well as to consider participation in competitive sports for asymptomatic individuals and with no disease repercussions.

Left ventricular noncompaction in a Para athlete / Miocárdio não compactado em paratleta

ABSTRACT The left ventricular noncompaction is a congenital cardiomyopathy characterized by the presence of abnormal trabeculations in the left ventricle. The present study describes the case of a 14-year-old female Para athlete, who plays goalball. She was asymptomatic, with history of congenital nystagmus and mild visual impairment, who presented nonspecific electrocardiographic abnormalities during pre-competition screening. Cardiac magnetic resonance imaging showed left ventricular non-compaction (non-compacted to compacted layer ratio equal to 2.5) and mild biventricular systolic dysfunction. Initially, the patient was excluded from sports participation and clinical follow-up was performed every three months. Patient remained asymptomatic during the one-year follow-up, with no history of unexplained syncope, marked impairment of systolic function or significant ventricular arrhythmias at the exercise stress test. Finally, she was released for competitive goalball participation and clinical follow-up was continued every 6 months. There is no consensus regarding the eligibility criteria for sports participation in cases of left ventricular non-compaction. Thus, it is prudent to individualize the decision regarding practice of sports, as well as to consider participation in competitive sports for asymptomatic individuals and with no disease repercussions.

RESUMO O miocárdio não compactado é uma cardiomiopatia congênita caracterizada pela presença de trabeculações anormais no ventrículo esquerdo. O presente estudo descreve o caso de uma paratleta de goalball, 14 anos, sexo feminino, assintomática, com história pessoal de nistagmo congênito e leve deficiência visual, que apresentou alterações eletrocardiográficas inespecíficas durante avaliação pré-participação. A ressonância magnética cardíaca evidenciou presença de não compactação miocárdica (relação entre camada não compactada/camada compactada igual a 2,5) e disfunção sistólica biventricular leve. Inicialmente, a paciente foi afastada da prática de esportes, e o seguimento clínico foi realizado a cada 3 meses. A paciente permaneceu assintomática durante o período de 1 ano de seguimento, sem história de síncope inexplicada, comprometimento significativo da função sistólica ou taquiarritmias ventriculares importantes ao teste de esforço. Por fim, ela foi liberada para prática competitiva de goalball, e o seguimento clínico foi mantido a cada 6 meses. Não há consenso quanto aos critérios de elegibilidade para a prática esportiva nos casos de miocárdio não-compactado. Assim, é prudente individualizar a decisão quanto a prática esportiva, bem como considerar a participação em esportes competitivos para indivíduos assintomáticos e sem repercussões da doença.

Post-transplant anemia and associated risk factors: the impact of steroid-free therapy.

CONTEXT AND OBJECTIVE: The prevalence of post-renal transplant anemia (PTA) reported in the literature is variable and several factors contribute towards its pathophysiology. This study aimed to investigate the prevalence of PTA, its associated risk factors and the impact of therapy without steroids. DESIGN AND SETTING: Retrospective cohort study in a renal transplantation unit at a tertiary hospital. METHODS: Anemia was defined as hemoglobin (Hb) < 12 g/dl in female adult recipients and < 13 g/dl in males. Donor and recipient age and gender, type of donor, creatinine, delayed graft function, acute rejection, use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and therapy without steroids were investigated as risk factors for PTA through multivariate logistical regression analysis. RESULTS: Evaluations were performed on 258 recipients (mean age: 38.8 years; 60.5% males; 35.7% did not receive steroids). Anemia was diagnosed in 38% of the patients (at the sixth month, M6), 28% (M12), 32% (M24) and 45% (at last follow up). Donor age > 50 years was associated with greater risks of PTA at M6 (odds ratio (OR) = 4.68) and M24 (OR = 6.57), as well as with therapy without steroids at M6 (OR = 2.96). Delayed graft function was independently associated with PTA at M6 (OR = 3.66) and M12 (OR = 2.85). CONCLUSION: The lowest prevalence of PTA was observed between M9 and M24 after renal transplantation. Delayed graft function, donor age and therapy without steroids were the most important factors associated with PTA.

Post-transplant anemia and associated risk factors: the impact of steroid-free therapy / Anemia pos-transplante e fatores de risco associados: o impacto da terapia sem esteroides

CONTEXT AND OBJECTIVE: The prevalence of post-renal transplant anemia (PTA) reported in the literature is variable and several factors contribute towards its pathophysiology. This study aimed to investigate the prevalence of PTA, its associated risk factors and the impact of therapy without steroids. DESIGN AND SETTING: Retrospective cohort study in a renal transplantation unit at a tertiary hospital. METHODS: Anemia was defined as hemoglobin (Hb) < 12 g/dl in female adult recipients and < 13 g/dl in males. Donor and recipient age and gender, type of donor, creatinine, delayed graft function, acute rejection, use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and therapy without steroids were investigated as risk factors for PTA through multivariate logistical regression analysis. RESULTS: Evaluations were performed on 258 recipients (mean age: 38.8 years; 60.5% males; 35.7% did not receive steroids). Anemia was diagnosed in 38% of the patients (at the sixth month, M6), 28% (M12), 32% (M24) and 45% (at last follow up). Donor age > 50 years was associated with greater risks of PTA at M6 (odds ratio (OR) = 4.68) and M24 (OR = 6.57), as well as with therapy without steroids at M6 (OR = 2.96). Delayed graft function was independently associated with PTA at M6 (OR = 3.66) and M12 (OR = 2.85). CONCLUSION: The lowest prevalence of PTA was observed between M9 and M24 after renal transplantation. Delayed graft function, donor age and therapy without steroids were the most important factors associated with PTA. .

CONTEXTO E OBJETIVO: A prevalência de anemia pós-transplante renal (APR) relatada na literatura é variável e vários fatores contribuem para sua fisiopatologia. Este estudo objetivou investigar a prevalência de APR, os fatores de risco associados e o impacto da terapia sem esteroides. TIPO DE ESTUDO E LOCAL: Estudo de coorte retrospectivo em unidade de transplante renal em hospital terciário. MÉTODOS: Anemia foi definida como hemoglobina (Hb) < 12 g/dl em receptores adultos do sexo feminino e < 13 g/dl no masculino. Idade e gênero do doador e do receptor, tipo de doador, creatinina, função retardada do enxerto (FRE), rejeição aguda, uso de inibidores da enzima conversora da angiotensina (IECA)/bloqueadores dos receptores da angiotensina (BRA) e terapia sem esteroides foram investigados como fatores de risco para APR em análise de regressão logística multivariada. RESULTADOS: Duzentos e cinquenta e oito receptores foram avaliados (idade média: 38,8 anos; 60,5% homens; 35,7% em terapia sem esteroides). Anemia foi diagnosticada em 38% no sexto mês (M6), 28% (M12), 32% (M24) e em 45% dos pacientes na última data de acompanhamento. Idade do doador > 50 anos associou-se a maior risco de APR aos 6 (odds ratio, OR = 4,68) e 24 meses (OR = 6,57), bem como terapia sem esteroides aos 6 meses (OR = 2,96). FRE associou-se independentemente com APR aos 6 (OR = 3,66) e 12 meses (OR = 2,85). CONCLUSÃO: A menor prevalência de APR foi observada entre 9 e 24 meses pós-transplante renal. FRE, idade do doador e terapia sem esteroides foram os principais fatores associados à APR. .

Morfometric study of arterial branching of the spleen compared to radiological study.

OBJECTIVE: To study the distribution of the branches of the splenic artery and relate it to the radiological study of its intraparenchymal distribution, aiming to use this knowledge in partial splenectomy. METHODS: In the macroscopic study, we used 60 human spleens which the splenic artery dissected from its origin to observe the division and the terminal branches directed to the spleen. We measured the distance between the visceral surface of the spleen and the terminal division of the splenic artery and the emergence of the polar branches. In the radiological study, we used 30 human spleens in which contrast was injected in the splenic artery to perform an arteriography and study the terminal division and polar branches. RESULTS: 93.34% of the spleens showed bifurcation and terminal pattern of division and 6.66% trifurcation. We identified secondary and tertiary side branches, having a relative frequency of 10% for type I, 17% for type II and 8.33% for both. The distance between the visceral surface of the spleen and terminal division was on average 2.89 cm and the emergence of type I polar artery was 4.85 cm and 2.39 cm for type II. In the 30 arteriographies we assessed the terminal division and bifurcation was observed in 90% of spleens and trifurcation in 10%, and the presence of polar arteries in 16% type I and type II in 20%. CONCLUSION: The splenic artery deisplays a bifurcation-type terminal division that can be viewed arteriographically. We highlight the existence of independent arterial segmentation in almost all cases (98%), similar in visceral and diaphragmatic surfaces of the spleen. Partial splenectomy is anatomical and the use of radiological methods becomes feasible in conservative treatment of splenic injuries.

Estudo morfométrico da divisão arterial do baço comparado ao estudo radiológico / Morfometric study of arterial branching of the spleen compared to radiological study

OBJETIVO: Estudar a distribuição dos ramos da artéria esplênica dirigidos ao baço aplicado ao estudo radiológico da sua distribuição intraparenquimatosa, visando à utilização destes conhecimentos na esplenectomia parcial. MÉTODOS: no estudo macroscópico, foram utilizados 60 baços humanos dos quais as artérias esplênicas foram dissecadas desde sua origem para visualizar a divisão terminal e os ramos dirigidos ao baço. Realizaram-se as medidas da distância entre a face visceral do baço e a divisão terminal da artéria esplênica e da emergência dos ramos polares. No estudo radiológico, utilizaram-se 30 baços humanos nos quais se injetou contraste nas artérias esplênicas para realizar as arteriografias e estudar a divisão terminal e ramos polares. RESULTADOS: 93,34 por cento dos baços apresentaram bifurcação como padrão de divisão terminal e 6,66 por cento trifurcação. Identificaram-se ramos colaterais secundários e terciários tendo como freqüência relativa de 10 por cento para o tipo I, 17 por cento para o tipo II e 8,33 por cento para ambas. A distância entre a face visceral do baço e a divisão terminal foi, em média, 2,89cm e para a emergência da artéria polar tipo I foi 4,85cm e 2,39cm para a tipo II. Nas 30 arteriografias realizadas, fez-se um estudo da divisão terminal no qual se observou bifurcação em 90 por cento dos baços e trifurcação em 10 por cento, além da presença de artéria polar tipo I em 16 por cento e tipo II em 20 por cento. CONCLUSÃO: a artéria esplênica apresenta divisão terminal do tipo bifurcação que pode ser visualizada arteriograficamente. Destaca-se a existência de segmentação arterial independente na quase totalidade dos casos (98 por cento), semelhantes nas faces visceral e diafragmática do baço. A esplenectomia parcial é anatômica e torna-se factível o emprego de métodos radiológicos no tratamento conservador das lesões esplênicas.

OBJECTIVE: To study the distribution of the branches of the splenic artery and relate it to the radiological study of its intraparenchymal distribution, aiming to use this knowledge in partial splenectomy. METHODS: In the macroscopic study, we used 60 human spleens which the splenic artery dissected from its origin to observe the division and the terminal branches directed to the spleen. We measured the distance between the visceral surface of the spleen and the terminal division of the splenic artery and the emergence of the polar branches. In the radiological study, we used 30 human spleens in which contrast was injected in the splenic artery to perform an arteriography and study the terminal division and polar branches. RESULTS: 93.34 percent of the spleens showed bifurcation and terminal pattern of division and 6.66 percent trifurcation. We identified secondary and tertiary side branches, having a relative frequency of 10 percent for type I, 17 percent for type II and 8.33 percent for both. The distance between the visceral surface of the spleen and terminal division was on average 2.89 cm and the emergence of type I polar artery was 4.85 cm and 2.39 cm for type II. In the 30 arteriographies we assessed the terminal division and bifurcation was observed in 90 percent of spleens and trifurcation in 10 percent, and the presence of polar arteries in 16 percent type I and type II in 20 percent. CONCLUSION: The splenic artery deisplays a bifurcation-type terminal division that can be viewed arteriographically. We highlight the existence of independent arterial segmentation in almost all cases (98 percent), similar in visceral and diaphragmatic surfaces of the spleen. Partial splenectomy is anatomical and the use of radiological methods becomes feasible in conservative treatment of splenic injuries.