Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data.

OBJECTIVE: Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. METHODS: A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. RESULTS: A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction. CONCLUSION AND RELEVANCE: The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.

Histomorphometry of the vesicourethral

To evaluate the elastic system fibers in the vesicourethral junction of wistar rats at different ages, histological and histomorphometric studies were conducted. The histology study of the elastic system fibers for selective staining methods showed the presence of three types of elastic fibers. In all age groups studied, histology study satisfactorily showed the structurals differences between the mature elastic fibers, elaunin and oxytalan fibers, which were located among the intercellular spaces of the muscular layer as well as between collagen fibers. Histomorphometric studies have revealed that with the advanced age, there is a decrease in the linear density of the mature elastic and oxytalan fibers, while the linear density of elaunin fibers has increased. Thus, it could be inferred that in the vesicourethral junction of old animals, there is a fall in the elasticity, elastic recoil and anchorage properties due a loss of elastin and microfibrils, but they are compensated by the elaunin fibers, since they show intermediate characteristics between mature elastic fibers and oxytalan fibers. It could be concluded that the aging process of the elastic fibers in the vesicourethral junction does not contribute alone and directly in the urinary incontinence state, but it compensates and gives muscular support, mainly due to the increase of the elaunin fibers, what makes the elastic system in the vesicourethral junction responsible for the maintenance of the urinary continence.

Preoperative plasma B-type natriuretic peptide (BNP) identifies abnormal transthoracic echocardiography in elderly patients with traumatic hip fracture.

INTRODUCTION: This prospective study was designed to evaluate whether preoperative plasma brain natriuretic peptide (BNP) could identify significant preoperative cardiovascular disease in elderly hip-fractured patients. PATIENTS AND METHODS: Preoperative plasma BNP measurement and rest transthoracic echocardiography (TTE) were performed within 24 h after admission in consecutive hip-fractured patients aged ≥65 years. The major echocardiographic abnormality (MEA) group included patients with at least one TTE abnormality, defined as systolic pulmonary artery pressure (PAP(s)) ≥50 mmHg, left ventricular (LV) systolic dysfunction, increased LV filling pressure (LVFP) or severe valvular disease. The control group included the remaining patients. RESULTS: Seventy-five patients (mean±SD (range) age=85±5 (69-97) years) were included during a 6-month period. Twenty-four (32%) patients constituted the MEA group (17 elevated PAP(s), three LV systolic dysfunctions, 10 increased LVFP, one severe aortic stenosis and one severe mitral regurgitation). Median (interquartile) preoperative BNP value was significantly greater in MEA than in the control group (527 (361) vs. 119 (154) pg ml(-1); p<0.0001). A preoperative plasma BNP cut-off value at 285 pg ml(-1) predicted well MEA with an area under the receiver operating characteristic (ROC) curve equal to 0.895 (p<0.0001) and with a hazard ratio (HR) (confidence interval, CI) of 23.8 (3.7-142.9) (p=0.0008) on multivariate analysis. The presence of MEA or BNP≥285 pg ml(-1) was associated with high mortality. DISCUSSION: The incidence of echocardiographic signs of elevated PAP(s) or elevated LVFP in elderly hip-fractured patients was high. A preoperative BNP value ≥285 pg ml(-1) can discriminate between elderly hip-fractured patients with or without MEA.

Use of recombinant factor VIIa (NovoSeven(®)) in 8 patients with ongoing life-threatening bleeding treated with fondaparinux.

BACKGROUND: Fondaparinux has a favourable efficacy-safety profile but if major bleeding occurs, reversal of antithrombotic treatment is challenging. We present clinical and biological observations from patients treated with rFVIIa for bleeding under fondaparinux. METHODS: Fondaparinux-treated patients with bleeding (>10% haematocrit decrease) and cardiovascular collapse were eligible. Patients received a single 90 µg/kg bolus rFVIIa. Clinical success was defined as clinical bleeding control without thrombotic complication. A biological criterion of successful antagonization was defined as a >100% increase in peak thrombin generation (C(max)). RESULTS: 8 patients were treated (5 ACS, 3 VTE). Patients received aspirin and clopidogrel (n = 5), eptifibatide (n = 2), fluindione (n = 5). In addition to standard haemostatic methods, all patients received rFVIIa and transfusion. Clinical progression was favourable in 4, with bleeding clinically controlled in <6 h. 1 patient died. Biological success was observed in 4 patients with lowest baseline anti-Xa (0.67-0.92 U/L); ¾ had clinical success. In patients with baseline anti-Xa >1.0 U/L (1.14-1.62 U/L), increase in C(max) was low; ¾ had no clinical bleeding control. CONCLUSION: This series is the largest describing rFVIIa use to control bleeding in patients under fondaparinux. rVFIIa was considered efficient in 50%, suggesting inefficacy in the context of elevated anti-Xa.

Histomorphometrical study of the elastic fiber system in the anterior cerebral artery of man.

The aim of the present study was to quantify the distribution of the elastic fiber system within the wall of the anterior cerebral artery. The study is based on the works of Glynn (1940) and Stehbens (1989) concerning the incidence and origin of brain aneurysms and recent studies of the elastic fibers. The anterior cerebral artery was divided into three segments, S1, S2 and S3: S1 corresponds to the origin of the anterior cerebral artery, S2 is located at the junction of the anterior cerebral artery with the anterior communicating artery, and S3 at the junction of the rostrum and genu of the corpus callosum,which were submitted to routine histological procedures. A histomorphometrical study was undertaken using an estimation of the linear density (Ld) of the components of the fibrous elastic system which evaluates their full length in each segment. Data were analyzed using first order linear regression methods. The results show a decreasing quantity of elastic fibers in the three segments (S1>S2>S3). Study of the elastic fiber system may originate new concepts regarding the genesis of cerebral artery aneurysm.

Angioarchitectural arrangements in corrosion cast of the nasal septum of the Mongolian gerbil.

The three-dimensional architecture of the vascular network of the nasal septum of the gerbil rat was studied using the corrosive resin cast technique. The angioarchitecture of the nasal septum observed with scanning electron microscopy (SEM) showed that a vascular network is disposed in the lamina propria. The capillaries, arterioles, venules and arteries were closely observed in different areas of the nasal septum mucosa.

A histomorphological study in age related changes in the elastic fiber system of the basilar artery.

The aim of the study was to quantify the distribution of elastic fibers within the wall of the basilar artery. Three age groups were studied: 1) 0-1 yr.; 2) 20-50 yr. 3) > 50 yr. A histomorphometrical study was undertaken using an estimation of the linear density of the components of the fibrous elastic tissue system: the full length in the proximal and distal segments of the basilar artery was evaluated. Our results showed that: The elastic tissue of the basilar artery is not evenly distributed throughout the tunica media. Compared to the 0 to 1-year age group, mature elastic, elauninic and oxytalan fibers decreased with age. In all age groups the linear density of the mature elastic fibers was more evident in the proximal than in the distal segment of the artery.

[The teaching of anatomy: a student view]. / O ensino da anatomia: uma visão discente.

This article contributes to the discussion of the Base Cycle discipline syllabus reformulation, specifically on the Anatomical field, at São Paulo University. Based on student board opinion poli, this article establishes objective indicators for teaching improvement of those disciplines, in a comparative manner to the faculty board conception.

Study on optic microscope of the muscle and elastic components of the aorto-iliac bifurcation septum and initial segment of the middle sacral artery.

In this work the aorto-iliac bifurcation septum and the initial segment of the middle sacral artery were analyzed through optic microscope. 20 anatomical pieces of corpses from subjects of both sexes aging from 20 to 33 years were examined. After collection of pieces and fixation in formaline for 48 hours, histological sections of 20 microns were made and stained with the methods of Weigert, Verhoeff and Picrofucsine of Van Gieson. It was observed that the middle sacral artery arises from the posterior aortic wall laterally to the aorto-iliac bifurcation septum. The sequential analysis of the sections showed that the septum is lined by a thickening of connective tissue along its length and elastic fibers predominate on its central portion. Bundles of muscle fibers prevail on the lateral and posterior regions. It was observed, above the origin of the middle sacral artery, a reorganisation of tissues which represents, more caudally, the ostium of the artery. It was verified that the middle sacral artery arises at the aorto-iliac bifurcation septum, which is a transitional region and should be classified of mixed type and called aorto-septo-sacral transition.

[Micro-mesoscopic study of the lateral wall of the human cavernous sinus]. / Estudo micro-mesoscópico da parede lateral do seio cavernoso humano.

The authors studied the structures of human cavernous sinus in its interior as well as on the lateral wall, utilizing thick, frontal, sequential sections. They show the significance of this wall, frequently used as surgical accessway to diseases encountered within this venous structure of the dura-mater.

Age-related changes in the human renal veins and their valves.

Age-related anatomical changes in the human renal veins and their valves were studied. The principal changes were: 1. The muscle fiber bundles were noted to progressively atrophy as a function of age, while conservely the elastic fiber bundles hypertrophied. 2. The valves of the renal veins were observed to become gradually thicker with age as a result of the increased number of collagen fiber bundles.

[Morphological study of human arachnoid granulations with reference to their classification]. / Estudo morfológico das granulações aracnóides humanas com referência a sua classificação.

Stereomicroscopic and microscopic study showed human arachnoid granulations with different morphology that we classified in simple and lobate. Simple granulations were small and completely involved by fibrous capsule that delimited a continuous subdural space from the pedicle to the apex. Lobate granulations were bigger than the simple; in the apex the fibrous capsule was thinner than in other regions, and fused with granulation periphery causing interruption of subdural space. Simple granulations might be an initial development stage; lobate granulations would represent a higher development stage, with ideal morphologic structure for absorption of the CSF.

Estudo morfológico das granulaçöes aracnóides humanas com referência a sua classificaçäo / Morphological study of human arachnoid granulations regarding their classification

O estudo das granulaçöes aracnóides humanas por esteromicroscópio e microscópio óptico revelou que em um mesmo indivíduo estäo presentes granulaçöes morfologicamente distintas, que classificamos em simples e lobuladas. As granulaçöes simples eram pequenas e completamente envoltas por cápsula fibrosa que delimitava, em torno das granulaçöes, espaço subdural contínuo desdce o pedículo até o ápice. As granulaçöes lobuladas eram maiores que as simples; em seu ápice a cápsula era delgada e ocorria interrupçäo do espaço subdural, devido à fusäo do tecido fibroso da cápsula com a periferia da granulaçäo. As granulaçöes simples estavam possivelmente em fase inicial de desenvolvimento, enquanto as granulaçöes lobuladas estariam em fase mais avançada, com estrutura morfológica ideal para absorçäo do LCR

Arachnoid granulation affected by subarachnoid hemorrhage.

The purpose of this study was to investigate using light microscopy the fibrocellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrhage. The erythrocytes were in the channels delimited by collagenous and elastic bundles and arachnoid cells, showing their tortuous and inter-communicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are disorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleus suggesting their transformation into phagocytic cells.

Arachnoid granulation affected by subarachnoid hemorrhage

Por microscopia óptica foram estudados os componentes fibrosos das granulaçöes aracnódes de indivíduos acometidos por hemorragia subaracnóide de tipo moderado ou severo. Os eritrócitos estavam presentes nos canais delimitados por feixes de fibras elásticas, colágenas e células aracnóides. Os canais tortuosos e intercomunicantes eram observados desde o pediculo até a cápsula fibrosa da granulaçäo aracnóide. O principal trajeto dos eritrócitos e do líquido cáfalo-raquidiano ocorria no interior do pedículo e centro da granulaçäo aracnóide. Na hemorragia severa, os compoentes fibro-musculares estavam desorganizados e os canais extra-celulares aumentados. A presença de células com grandes núcleos, observada no material hemorrágico, é sugestiva de transformaçöes das células aracnóides em células fagocitárias, para promover a digestäo intracelular dos eritrócitos

Arquitetura morfofuncional das veias testiculares em adulto / Morphofunctional architecture of testicular veins in adults

A correlaçäo entre a varicocele e a esterilidade masculina levou-nos a estudar a arquitetura das veias testiculares. Foram utilizados 12 cadáveres, com idade variando entre 23 e 64 anos. Isoladas as veias testiculares em toda sua extensäo e fixadas em soluçäo de formol a 10//, foram obtidos cortes seriados espessos e corados para evidenciar os tecidos muscular e fibroso. O arranjo dos feixes de fibras musculares mostra disposiçäo diferente ao nível das desembocaduras à direita e à esquerda. O arranjo do tecido fibroso é semelhante ao do tecido muscular. A análise micromesoscópica mostra sistemas músculo-fibrosos adaptados a regulaçäo do fluxo sanguíneo nas junçöes venosas cavo e renotesticular

[Morphofunctional architecture of the testicular veins in adults]. / Arquitetura morfofuncional das veias testiculares em adultos.

The correlation between varicocele and male sterility, mentioned by several authors, led us to study the disposition of the testicular veins, especially at the level of their ending, trying to provide an anatomical description, which may contribute with new etiopathogenic information, in order to interpret that pathologic entity. The arrangements of the muscular fiber bundles show a different disposition in the right and left side, mainly in their distinct orientation. The collagen and elastic tissue show an arrangement similar to the muscular fibers, in order to improve the blood flow, sometimes in the reno-testicular and sometimes in the cavo-testicular junction.

The vertebral artery: its relationship with adjoining tissues in its course intra and inter transverse processes in man.

The authors study the vertebral artery from its origin to termination, especially in its course inter and intra transverse process and show its relation to venous and nervous structures, as well as its behavior toward adjacent conjunctive tissue. They discuss the relation of the anatomy to the physiopathology of the vertebral artery and come to the conclusion that the vertebral artery is fixed to adjacent structures in the fibrous osteomuscular tunnel by means of a continuous lamina of collagen along its entire course and that there is considerable independence between the artery and the branches of these final nerves.

Morphology, distribution and types of valves in the adult male's testicular veins.

Morphologically, the pampiniform plexuses investigated had, in their majority, no vascular spiraling on the left side, the same occurring on the right side; however, as for the total number of valves, except for those of the pampiniform plexuses, the left side was found contain a greater number of valves. As regards valve types, there is a predominance of double semilunar one on both sides rather than single semilunar valves.

Microscopic anatomy of the human vertebro-basilar system.

Concerning the structure of connective-muscular components the authors studied the walls of the terminal segments of the vertebral arteries as well as the basilar artery, utilizing the following staining methods: Azan modified by Heidenheim, Weigert's resorcin-fuchsin, and Weigert modified by van Gieson. It was established that wall of the vertebro-basilar system exhibits a mixed structure, muscular and elastic, by means of which the vessels are adjusted to the specific blood circulation conditions. Thus, vertebral arteries show in the most external layer of tunica media an evident external elastic lamina. In contrast, in the basilar artery the elastic tissue is localized mainly in the tunica media, and is distributed heterogeneously. In its caudal segment the elastic fibers are situated in the most internal layer of tunica media, and in the cranial segment the elastic component is homogeneously distributed in the whole of tunica media.