[Atrioventricular junction ablation: therapy of refractory atrial tachyarrhythmia]. / Ablação da junção aurículo-ventricular: Terapêutica de recurso de taquiarritmias auriculares refractárias.

OBJECTIVES: To assess the safety and efficacy of radiofrequency atrio-ventricular junctional ablation. DESIGN: Consecutive group of patients with refractory atrial tachyarrhythmias in whom catheter ablation of the atrio-ventricular junction was performed. SETTING: Cardiology Department at University Hospital. INTERVENTIONS: Atrio-ventricular junctional ablation was performed in 13 patients with a mean age of 53 +/- 13 years. Among six patients there was no evidence of organic heart disease, two had operated congenital heart disease, two had hypertensive heart disease, one had rheumatic heart disease with a prosthetic valve and the other had ischemic heart disease. The indication for ablation was drug-refractory atrial tachyarrhythmia in all patients: atrial fibrillation with uncontrolled rate in eight patients, atrial flutter in three, atrial tachycardia in one and inappropriate sinus tachycardia in one. An average of 3.7 +/- 0.9 anti-arrhythmia drugs was previously ineffective or associated with significant side-effects. Radiofrequency energy was applied between the distal pole of the ablation catheter and an indifferent cutaneous electrode with intensity of 40-65 volts for 30-60 secs. The ablation was initially performed utilizing the classical technique with the ablation catheter across the tricuspid valve. In the case of failure, an alternative method was used, with the ablation catheter positioned in the left ventricular septum. After the procedure a VVI-R permanent pacemaker was inserted in all patients. MEASUREMENTS AND RESULTS: Atrio-ventricular junctional ablation was successful in all patients after an average of 4.4 +/- 3.7 radiofrequency applications. The classical technique was successful in 11 patients (85%). The average amplitude of the His bundle electrogram recorded in the successful sites was not significantly different from the average maximum amplitude at unsuccessful sites (0.1 +/- 0.05 mV vs. 0.17 +/- 0.12 mV). There were no complications related to the procedures. During a mean follow-up of 7 +/- 4 months there was functional and symptomatic improvement in all patients. The only significant complication was an episode of sustained ventricular tachycardia that occurred three months after the ablation in a patient with Tetralogy of Fallot. CONCLUSIONS: In patients with refractory atrial tachyarrhythmias, atrio-ventricular junctional ablation is a safe and effective therapeutic option. The alternative technique should be reserved for cases of unsuccessful ablation with the classic method. Due to its potential significant side-effects, this therapy should be a last alternative option.

[Efficacy and safety of adenosine triphosphate in the control of supraventricular paroxysmal tachycardia]. / Eficácia e segurança do trifosfato de adenosina na terminação de taquicardia paroxística supraventricular.

Our purpose was to assess the efficacy and safety of intravenous ATP for the acute termination of paroxysmal supraventricular tachycardia. There were 14 women and 10 men, aged 38 +/- 15 years. Three patients had evidence of structural heart disease (Ebstein's anomaly associated to atrial septal defect, operated mitral stenosis with insertion of a mechanical heart valve and CAD respectively). Twelve patients had Wolff-Parkinson-White syndrome and another had undergone surgical ablation of an accessory pathway. At the time of electrophysiologic testing, ATP was administered during episodes of paroxysmal supraventricular tachycardia, via a central vein, in incremental doses of 5, 10 and 20 mg followed by a flush of 10 c.c. of isotonic saline. The mechanism of the arrhythmia was orthodromic AV reentrant tachycardia in 19 (79%), AV nodal reentrant tachycardia in 4 (16.6%) and atrial tachycardia in one patient. The mean frequency of the tachycardia was 174 +/- 33 b.p.m. A dose of 5 mg was effective in 16 patients (66%), 5 required 10 mg and two required 20 mg for termination of the tachycardia. In the patient with atrial tachycardia ATP was not effective. The average time after injection to termination of the arrhythmia was 16 +/- 8 seconds. Orthodromic AV reentrant tachycardia was interrupted in the AV node limb in all but one patient and AV nodal reentry was terminated in the "slow-pathway" in three of the four patients. Nine patients had premature ventricular complexes, isolated or in couplets, after the termination of the SVT. Three patients had immediate recurrence of the SVT.(ABSTRACT TRUNCATED AT 250 WORDS)

[The diagnosis and ablation of accessory atrioventricular pathways in the initial electrophysiological exam: a new therapeutic modality in pre-excitation syndromes]. / Diagnóstico e ablação de vias acessórias aurículo-ventriculares no exame electrofisiológico inicial: nova modalidade terapêutica dos síndromes de pré-excitação.

OBJECTIVE: To describe the experience and results in the diagnosis and catheter ablation of atrioventricular accessory (AP) pathways during the initial electrophysiologic study. DESIGN: We performed catheter ablation at the time of an initial electrophysiologic study in 22 consecutive patients (12 W and 10 M, mean age 42 +/- 15) with Wolff-Parkinson-White syndrome or supraventricular tachycardia. SETTING: Cardiology Department at University Hospital. INTERVENTIONS: The precise AP mapping was performed with the ablation catheter (4 mm distal electrode and deflectable tip) according to the earlier ventricular activation during sinus rhythm or the earlier atrial activation during ventricular pacing or orthodromic reentrant tachycardia. For left-sided pathways the ablation catheter was positioned on the mitral annulus retrogradely across the aortic valve, while for right-sided pathways it was positioned on the tricuspid annulus or near the coronary sinus os. Radiofrequency energy was applied for 20-60 segs with 55-65 Volts. MEASUREMENTS AND RESULTS: Seventeen AP were manifest and five were concealed. AP were left lateral in 11 patients (50%), left posterior in 5, and right postero-septal, right posterior or antero-septal in 2 patients each. The ablation was initially successful in 18/22 (82%), with 9 +/- 8 radiofrequency applications. Mean duration of the entire procedure was 145 +/- 59 min and the fluoroscopy duration was 39 +/- min. There were no major complications. During 2-9 months of follow-up AP conduction returned in two patients. CONCLUSIONS: Radiofrequency catheter ablation of AP is effective and safe and can be performed at the time of an initial electrophysiologic test, avoiding the need for long-term antiarrhythmic drug therapy or surgical ablation.

Determinacao do volume da perda sanguinea menstrual e correlacao com algumas causas de sua variacao. / Measurement of menstrual blood loss and relationship with some causes of its variation

Procurou-se correlacionar ate que volume a perda sanguinea mentrual pode conduzir ao aparecimento de anemia ferropriva em mulheres. Para isso, determinou-se a quantidade de sangue perdido em 211 menstruacoes, pelo metodo de Hallberg & Nilsson. O volume medio foi de 40 ml e o uso de pilulas anovulatorias reduziu essa quantidade a 20,2 ml. A eliminacao de mais de 40 ml de liquido menstrual por ciclo coincidiu com quadros de anemia carencial, mostrando que o limite entre uma menstruacao normal e uma patologica e muito pequeno, nos casos estudados. Por outro lado a avaliacao subjetiva do volume mentrual feito pela propria paciente apresentou-se pouco confiavel

O ketoconazole no tratamento da candidiase vulvovaginal. / Ketoconazole in the treatment of vulvovaginal candidosis

O autor tratou 22 pacientes portadoras de candidiase vulvovaginal, aguda e cronica, com ketoconazole oral, utilizando a posologia de dois comprimidos de 200 mg ao dia, durante cinco dias consecutivos. Todas as pacientes tiveram confirmacao diagnostica, atraves de exame microscopico e cultura em meio de Nickerson, antes de sua inclusao no estudo e os controles para confirmacao de cura, realizados no 7o. e 30o. dia apos a ingestao do ultimo comprimido, observaram ao mesmo criterio. O percentual de cura clinica e laboratorial alcancou 95,7% no primeiro controle e 87% ao final do segundo controle e tivemos apenas um caso discreto e passageiro de nausea, traduzindo a boa tolerancia ao medicamento. Os sinais e sintomas desapareceram rapidamente e assim permaneceram em 91,3% dos casos ate o final do ensaio

Tratamento da tricomoniase vaginal pelo tinidazol em dose unica. / Treatment of vaginal trichomoniasis with tinidazole in single dose

Os AA. avaliaram a eficacia terapeutica do Tinidazol na tricomoniase urogenital em 69 pacientes atraves de estudo aberto comparativo. A posologia utilizada foi de 2g via oral em dose unica. Foram realizados exames microscopicos "a fresco" e cultura pelo metodo de Feinberg e Whittington, modificado por Stenton. Quarenta e quatro pacientes realizaram os controles no setimo dia e no final do tratamento, enquanto que em 24 pacientes foram realizados controles apenas no setimo dia Foi obtida cura microscopica em 88,2% dos pacientes no setimo dia e em 97,7% no trigesimo dia. A cultura mostrou-se negativa em 82,3% dos pacientes no setimo dia e em 93,1% no trigesimo dia. Foram observados efeitos colaterais leves em 32,35% dos pacientes. O tinizadol em dose unica de 2g via oral mostrou-se extremamente eficaz no tratamento da tricomoniase e destituido de efeitos colaterais maiores