Tecnologia educativa audiovisual voltada às mulheres na atenção básica sobre aceitabilidade do dispositivo intrauterino no pós-parto / Audiovisual educational technology aimed at women in primary care about the acceptability of the intrauterine device in the postpartum / Tecnología educativa audiovisual dirigida a mujeres en atención primaria sobre la aceptabilidad del dispositivo intrauterino en el posparto

Objetivo: desenvolver tecnologia educativa audiovisual de animação gráfica sobre aceitabilidade de mulheres durante o pré-natal frente ao uso do Dispositivo Intrauterino pós-parto imediato. Método: elaboração do produto tecnológico em três etapas: pré-produção, produção e pós-produção. O produto foi iniciado após obtenção dos resultados do questionário com perguntas de resposta aberta. O storyboard foi dividido em conteúdo/roteiro, imagem/cena e som, com três personagens, repórter, médica e paciente. A tecnologia educativa audiovisual foi fragmentada em quatro partes, quais sejam: sinopse, argumentos, roteiro e storyboard. Resultados: das 746 mulheres, 46,9% não aceitaram a inserção do Dispositivo Intrauterino. Na análise, a não aceitação ao Dispositivo Intrauterino resultou em uma tecnologia leve-dura em formato audiovisiual para promoção do aumento do uso do dispositivo no pós-parto. Conclusão: o diagnóstico situacional apontou o desejo de outro método contraceptivo e medo como principais motivos de não aceitabilidade do Dispositivo Intrauterino, embasando a essência de construção da tecnologia educativa.

Objective: to develop audiovisual educational technology of graphic animation on the acceptability of women during prenatal care in the face of the use of the immediate postpartum Intrauterine Device. Method: development of the technological product in three stages: pre-production, production and post-production. The product was started after obtaining the results of the questionnaire with open-ended questions. The storyboard was divided into content/script, image/scene and sound, with three characters, reporter, doctor and patient. The audiovisual educational technology was divided into four parts, namely: synopsis, arguments, script and storyboard. Results: the of 746 women, 46.9% did not accept the insertion of the Intrauterine Device. In the analysis, the non-acceptance of the Intrauterine Device resulted in a light-hard technology in audiovisual format to promote increased use of the device in the postpartum period. Conclusion: the situational diagnosis pointed to the desire for another contraceptive method and fear as the main reasons for the non-acceptability of the Intrauterine Device, supporting the essence of the construction of educational technology.

Objetivo: desarrollar tecnología audiovisual educativa de animación grá- fica sobre la aceptabilidad de la mujer durante el prenatal frente al uso del Dispositivo Intrauterino posparto inmediato. Método: desarrollo del producto tecnológico en tres eta- pas: preproducción, producción y postproducción. El producto se inició luego de obtener los resultados del cuestionario con preguntas abiertas. El storyboard se dividió en conte- nido/guión, imagen/escena y sonido, con tres personajes, reportero, médico y paciente. La tecnología educativa audiovisual se dividió en cuatro partes, a saber: sinopsis, argu- mentos, guión y guión gráfico. Resultados: de 746 mujeres, el 46,9% no aceptó la inser- ción del Dispositivo Intrauterino. En el análisis, la no aceptación del Dispositivo Intra- uterino resultó en una tecnología light-hard en formato audiovisual para promover un mayor uso del dispositivo en el puerperio. Conclusión: el diagnóstico situacional apuntó el deseo por otro método anticonceptivo y el miedo como los principales motivos de la no aceptabilidad del Dispositivo Intrauterino, sustentando la esencia de la construcción de la tecnología educativa.

Differential distribution of vitamin D receptor (VDR) gene variants and its expression in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disorder that displays an important genetic background. Vitamin D3 (VD3 ) through its receptor (VDR) plays an important immunomodulatory role in autoimmune misbalance, being capable of modulating immune responses. Genetic alterations in VDR gene may contribute to an altered risk in SLE development and clinical manifestations. We investigated VDR SNPs (single nucleotide polymorphisms) frequencies in 128 SLE patients and 138 healthy controls (HC) and mRNA differential expression in 29 patients and 17 HC regarding SLE susceptibility as well as clinical features. We observed that rs11168268 G allele (OR = 1.55, p = .01) and G/G genotype (OR = 2.69, p = .008) were associated with increased SLE susceptibility. The rs2248098 G allele and A/G and G/G genotypes were associated to lower SLE susceptibility (OR = 0.66, p = .01; OR = 0.46, p = .01; OR = 0.44, p = .02, respectively). Regarding clinical features, we observed lower risk for: rs11168268 A/G genotype and nephritis (OR = 0.31, p = .01); rs4760648 T/T genotype and photosensitivity (OR = 0.24, p = .02); rs1540339 T/T genotype and antibody anti-dsDNA (OR = 0.19, p = .015); rs3890733 T/T genotype and serositis (OR = 0.10, p = .01). We identified a significant downregulation in VDR expression levels when compared patients and controls overall (p = 1.04e-7 ), in Cdx-2 A/G and G/G (p = .008 and p = .014, respectively) and in patients with nephritis (p = .016) Our results suggested that VDR SNPs influence upon SLE susceptibility and in particular clinical features, acting on mRNA expression in SLE patients overall and the ones with nephritis.

Espiritualidade e qualidade de vida em médicos que convivem com a finitude da vida / Spirituality and quality of life of physicians who work with the finitude of life

Abstract: Introduction: In the medical field there are still gaps regarding the concept of death and the finitude of life, very often understood as a failure of Medicine and not as an integral part of existence. In this context, the view of death as an error, the failure of a treatment, generates anxiety and demands by doctors themselves, which can affect their physical, mental and spiritual health. Objective: To analyze the relationship between spirituality, religious practices, and quality of life of medical professionals in the field of oncology and palliative care who deal with the finitude of life on a daily basis in a reference hospital in northeastern Brazil. Method: Cross-sectional, analytical and quantitative study with an intentional and convenience sample. Questionnaires were applied to describe the sociodemographic profile, quality of life (WHOQOL - bref) and spirituality using the Brief Religious/Spiritual Coping Scale (Brief RCOPE) and the Spirituality Self Rating Scale (SSRS). Data analysis used the Statistical Package for the Social Sciences (SPSS), version 13.0 for Windows. The study was approved by the REC of IMIP under Opinion 2,890,118. Result: Twenty oncologists and palliative care physicians participated in the study; most were women (55%), of white ethnicity (60%), Catholic (80%) and married (70%). The SSRS scale identified an average score of 21.75. In the Brief RCOPE, the positive aspect scored 2.64, the negative aspect 1.47, and the total aspect 2.04. There was a significant positive association between the SSRS and RCOP results (p=0.0). When associating WHOQOL - bref with Brief RCOPE, a direct relationship with statistical significance of the psychological domain was obtained with total RCOP (p-value: 0.01) and with negative RCOP (p-value: 0.03). Conclusion: The study showed a relationship between spirituality and quality of life, as well as positive aspects of faith for coping with everyday stress, corroborating the discussion of the importance of including spirituality as a protective factor in health.

Resumo: Introdução: Na área médica, ainda existem lacunas no que tange à concepção de morte e à finitude da vida, muitas vezes entendida como falha da medicina e não como parte integrante da existência. Nesse contexto, a visão da morte como um erro, um insucesso de um tratamento, gera ansiedade e cobrança por parte dos próprios médicos, podendo afetar sua saúde física, mental e espiritual. Objetivo: Este estudo teve como objetivo analisar a relação entre espiritualidade, práticas religiosas e qualidade de vida de profissionais médicos da área de oncologia e cuidados paliativos que convivem diariamente com a finitude da vida em hospital de referência do Nordeste brasileiro. Método: Trata-se de um estudo transversal, analítico e quantitativo com amostra intencional e por conveniência. A coleta de dados foi realizada por meio de um questionário sociodemográfico, e adotaram-se os seguintes instrumentos: World Health Organization Quality of Life-bref (WHOQOL-bref), Escala de Coping (Enfrentamento) Religioso-Espiritual Abreviada (CRE-Breve) e Spirituality Self Rating Scale (SSRS). A análise dos dados utilizou o Statistical Package for the Social Sciences (SPSS) 13.0 para Windows. O estudo foi aprovado pelo CEP do IMIP sob o Parecer nº 2.890.118. Resultado: Participaram do estudo 20 médicos oncologistas e paliativistas: a maioria sendo mulheres (55%), brancos (60%), católicos (80%) e casados (70%). A SSRS identificou um escore médio de 21,75. Na Escala CRE-Breve, o aspecto positivo ficou com pontuação de 2,64, o aspecto negativo em 1,47 e o aspecto total com 2,04. Houve associação positiva significativa entre os resultados da SSRS e CRE (p = 0,0). Quando se associou a WHOQOL-bref com a CRE-Breve, foi obtida relação direta com significância estatística do domínio psicológico com CRE total (p-valor: 0,01) e com o CRE negativo (p-valor: 0,03). Conclusão: O estudo apontou uma relação entre a espiritualidade e a qualidade de vida, assim como aspectos positivos da fé para o enfrentamento do estresse cotidiano, corroborando com a discussão da importância de incluir a espiritualidade como fator protetor na saúde.

Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography.

OBJECTIVES: Our goal was to compare results between a standard computed tomography (CT)-based strategy, the 'three-step preoperative sequential planning' (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS: We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS: Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS: In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay.

Use of SGLT2 Inhibitors in Older Adults: Scientific Evidence and Practical Aspects.

Diabetes mellitus (DM) is an increasingly prevalent condition that has a significant impact on health systems worldwide, particularly in older people. It is estimated that 30% of people aged > 65 years fulfil the diagnostic criteria for DM, with 90% having type 2 DM (T2DM). Generally, specific guidelines for the treatment of T2DM in older people address in a very limited manner the use of more recent therapies, such as sodium-glucose co-transporter-2 inhibitors (SGLT2i), which have important benefits for older people, such as a low risk of hypoglycemia, reduction of cardiovascular and renal risk, and an insulin-independent mechanism, allowing its use in disease of any duration. The SGLT2i class is well-tolerated, though some caution is also suggested, including adjustment of concomitant therapies, such as insulin and antihypertensives, especially loop diuretics. This review discusses the pathophysiological characteristics of the older patient with T2DM and evaluates the main benefits of and cautions for the use of SGLT2i in this population.

Differential expression of the inflammasome complex genes in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving heterogeneous clinical manifestations and numerous susceptibility genes. Several findings evidence the critical role of inflammasomes in the predisposition to autoimmune diseases and in SLE. We investigated whether inflammasome polymorphins could affect susceptibility to develop and/or severity SLE. Moreover, differences in inflammasome activation in peripheral blood were also evaluated in SLE patients and controls. The distribution of 13 SNPs in eight inflammasome genes was evaluated. To assess inflammasome priming in peripheral blood monocytes of SLE and controls, differential expression of selected inflammasome genes and IL-1ß production was analyzed in resting condition as well as after LPS and ATP stimulation. Results showed that the gain-of-function variant rs10754558 (NLRP3) was significantly more frequent in SLE patients with nephritis, reinforcing the concept of a key role of NLRP3 inflammasome not only in SLE but also especially in kidney disease. SLE monocytes in resting condition showed a higher level of IL-1ß expression and produced higher levels of IL-1ß when stimulated with LPS+ATP comparing to controls. The stimulation induced a significant expression of NLRP1, AIM2, CASP1, and IL1B genes, suggesting that the NLRP1 inflammasome is responsible for the IL-1ß production observed in monocytes. These data emphasized once more the important contribution of inflammasome in SLE-associated inflammation.

T-cell specific upregulation of Sema4A as risk factor for autoimmunity in systemic lupus erythematosus and rheumatoid arthritis.

The aim of the present study was to evaluate the impact of SEMA4A genetic variants on expression of sema4A protein and its relation to autoimmunity development in Systemic Lupus Erythematosus and Rheumatoid Arthritis patients. A total of 541 SLE patients, 390 RA patients and 607 healthy individuals were genotyped. We also assessed SEMA4A mRNA expression from whole blood cells and the in vitro protein production from resting and activated T lymphocytes as well as mature dendritic cells from healthy individuals stratified according to their genotypes for SLE/RA associated SEMA4A variants. Our results showed that T/T genotype for rs3738581 SNP is associated with both RA and SLE development (p = .000053, OR = 2.35; p = .0019, OR = 2.07, respectively; statistical power = 100%) and also to an increased in vitro sema4A production in active T lymphocytes. Our findings are indicative of a T cell-specific upregulation of sema4A in the presence of T/T genotype, being a risk factor for SLE and RA.

Diabetes mellitus no Brasil: características clínicas, padrão de tratamento e custos associados ao cuidado da doença / Diabetes Mellitus in Brazil: clinical characteristics, standard treatment choice and cost

Objetivo: Descrever a utilização de recursos de saúde associados ao tratamento do Diabetes Mellitus tipo 2 (DM2) no sistema público de saúde brasileiro, assim como o padrão de tratamento e seus eventos adversos, a ocorrência de complicações vasculares e o controle metabólico nos pacientes. Métodos: Estudo observacional, retrospectivo, conduzido em 4 centros do Sistema Único de Saúde envolvendo pacientes com DM2. Os dados foram coletados dos prontuários médicos de setembro a dezembro de 2013. Foi conduzida análise descritiva considerando três faixas de duração da doença desde o seu diagnóstico e a estratificação dos pacientes de acordo com o período recordatório e presença de complicações vasculares. Resultados: 161 pacientes foram analisados. Os principais esquemas terapêuticos utilizados foram a combinação de metformina, insulina NPH e insulina regular; de glibenclamida e metformina; e metformina isolada. A associação metformina e insulina apresentou maior frequência de eventos adversos (28,9%) e a glibenclamida, metformina e insulina, menor frequência (5,7%). A maioria dos pacientes mostrou complicações microvasculares, sendo nefropatia e neuropatia frequentes em todos os estratos analisados. Em pacientes com DM2 avançado (≥ 15 anos de duração), a retinopatia mostrou-se prevalente. A frequência de eventos macrovasculares variou de 21,3% a 37,9% entre os grupos, sendo a doença coronariana a mais frequente. Um custo total médio de R$ 931,88±1.400,75 por paciente foi observado para os pacientes sem complicações vasculares e de R$ 1.212,37±1.012,38 para aqueles com complicações. Conclusão: Informações relevantes sobre o manejo de pacientes brasileiros com DM2 foram descritas, sugerindo alta frequência de complicações vasculares e maiores custos associados a elas.

Objective: The aim of this study is to describe the use of public health resources to Type 2 Diabetes Mellitus (T2DM) and its costs in Brazil. Furthermore, we describe the standard treatment choice and its related adverse events as well as patients' metabolic control and vascular complications. Methods: This observational and retrospective study was conducted in four public health centers from Brazilian Public Health System (SUS); a secondary assistance level for long-term treatment for outpatients with T2DM. Data were collected from medical records from September to December 2013. A descriptive analysis is available for three groups according to time of disease since diagnosis. The recall and vascular complications were also considered. Results: 161 patients were studied. The most frequent treatments were metformin in monotherapy, metformin + NPH insulin + regular insulin and metformin + glibenclamide. Metformin + insulin therapy had the highest rate of adverse events (28.9%), while glibenclamide + metformin + insulin therapy, the lowest rate (5.7%). The majority of patients developed microvascular complications, specially nephropathy and neuropathy. Retinopathy was the most frequent complication for the group of patients with end stage T2DM (≥ 15 years). The frequency of macrovascular events ranged from 21.3% to 37.9% between groups. Coronary disease was the most frequent macrovascular complications. The mean cost per patient was R$ 1.212,37±1.012,38 for patient group presenting vascular complications and R$ 931,88±1.400,75 for the group not presenting complications. Conclusion: We describe current use of public health resources regarding T2DM treatment in Brazil, as well as T2DM treatment´s characteristics.

Vitamin D receptor polymorphisms and expression profile in rheumatoid arthritis Brazilian patients.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and important joint commitment, being the most common systemic autoimmune disease worldwide. RA displays important genetic background with a variety of genes contributing to the immune balance breakdown. Recent studies have demonstrated that vitamin D, through its receptor (VDR), is able to regulate the immune balance and suppress the autoimmunity process, being a potential target in autoimmune diseases. In the present genetic association study, we assessed 5 Tag single nucleotide polymorphisms (SNPs) (rs11168268, rs2248098, rs1540339, rs4760648 and rs3890733), which cover most of the VDR gene, in three different Brazilian populations (from Northeast, Southeast and South Brazil). We also evaluated the VDR expression profile in whole blood and monocytes from RA patients. For genotyping study, 428 RA patients and 616 healthy controls were genotyped with fluorogenic allele specific probes on an ABI7500 platform. For gene expression study, VDR mRNA levels of 15 RA patients and 26 healthy individuals were assessed by RT-PCR. Our results showed that SNPs rs4760648 and rs3890733 are associated to RA susceptibility (p value = 0.0026, OR 1.31 and p value = 0.0091, OR 1.28 with statistical power = 0.999 and 0.993, respectively). Regarding RA clinical features, the studied SNPs did not show significant associations. The gene expression assays showed that VDR mRNA levels were down regulated in both whole blood (-3.3 fold) and monocytes (-3.2 fold) of RA patients when compared to healthy controls. Our results, the first reported for distinct Brazilian populations, support a role of the VDR gene in the susceptibility to RA.

Características dos pacientes em serviço privado de cardiologia pediátrica: análise de sete anos / Characteristics of patients in private pediatric cardiology unit: seven-year analysis

Fundamentos: Apesar dos avanços no diagnóstico etratamento das cardiopatias na infância, as cardiopatias congênitas figuram como fator de destaque namorbimortalidade neonatal. Cardiopatias adquiridas,como a febre reumática, também têm alto impacto nasaúde pública. Logo, o conhecimento do perfil dessescardiopatas é importante para focalizar recursos eotimizar resultados. Objetivo: Descrever os principais achados clínicos ediagnósticos de pacientes atendidos em clínica privadade cardiologia pediátrica por faixa etária. Métodos: Analisados 17873 prontuários de pacientesatendidos nos últimos sete anos, com ênfase em: sexo, idade, motivo do encaminhamento, principais achadosna história da doença atual, achados ao exame físico,exames complementares realizados e principais diagnósticos ao ecocardiograma. Resultados: Houve predomínio do sexo masculino(53,7 %). A média de idade foi 63,5 meses, compacientes abaixo de 2 anos representando aproximadamente 25,0 % da amostra. O motivoprincipal do encaminhamento foi o parecer cardiológicoem pacientes acima de 2 anos, e suspeita de cardiopatianas faixas etárias menores. Ao exame físico, 59,8 %apresentavam anormalidades, com sopro presente em35,8%. O ecocardiograma foi realizado em 96,93% daamostra. Dentre as cardiopatias detectadas ao ecocardiograma, as mais frequentes foram as de shuntE-D (62,75%). Conclusão: A maioria das cardiopatias ocorreu empacientes de menor faixa etária no momento doencaminhamento. A diferença entre as faixas etáriasfoi essencial na diferenciação das cardiopatias e dosachados clínicos.

Background: Despite advances in the diagnosis andtreatment of heart diseases during childhood, congenital heart defects remain a prominent factor in neonatal morbidity and mortality. Acquired heart diseases, such as rheumatic fever, also have high impact on public health. Knowledge of these cardiac patient profiles is thus important for focus ingresources and optimizing results. Objective: To describe the main diagnostic and clinical findings for patients seen at a private pediatric cardiology center, by age bracket. Methods: We analyzed 17,873 records for patients seen during the past seven years, emphasizing: gender, age, reason for referral, the main findings in the history of the current disease, main findings from physical examinations, supplementary tests and the main diagnoses through echocardiograms. Results: There was a predominance of males (53.7%), with an average age of 63.5 months, with some 25% of the sample younger than two years of age. The main reasons for referral were cardiological reports for patients more than two years old, and suspected CHD for younger children. On physical examination, 59.8% presented anomalies, with murmurs found in 35.8%. Echocardiography was performed for 96.93% of the sample. The most frequent CHDs detected by echocardiography were left-to-right shunt lesions (62.75%).Conclusion: Most CHDS were found in younger children, on referral. The difference between the age brackets was essential for distinguishing CHDs and clinical findings.

Pulmonary hypertension in infants linked to horseshoe lung: case report.

This is the case report of a young infant with early respiratory distress and pulmonary hypertension, diagnosed as a variant of horseshoe lung and we have reviewed the literature to seek information about this rare pulmonary malformation and its cardiac and hemodynamic repercussions.

Implante de stent na via de saída de ventrículo direito: alternativa à paliação cirúrgica convencional? / Stenting the right ventricle outflow tract: is it an alternative to palliative surgery?

O uso de stents intravasculares em crianças com cardiopatia congênita é procedimento bem estabelecido, porém a indicação de paliação por meio de procedimentos percutâneos ao invés da cirurgia convencional permanece incerta. Neste relato são apresentados três casos de obstrução crítica de via de saída do ventrículo direito (VSVD), submetidos a ampliação da VSVD com implante de stent. O implante foi realizado com sucesso nos três casos, permitindo restabelecer o fluxo pulmonar para a árvore pulmonar e melhorar a saturação de oxigênio.

The use of intravascular stents in children with congenital heart disease is well established, however the use of palliative percutaneous therapy instead of a conventional surgery remains uncertain. We present three cases of critical right ventricular outflow tract (RVOT) obstruction treated with stenting to expand the RVOT. Stenting was successful in all three cases, reestablishing pulmonary flow into the pulmonary arteries and improving oxygen saturation.

Hipertensão pulmonar em lactente associada a pulmão em ferradura: relato de caso / Pulmonary hypertension in infants linked to horseshoe lung: case report / Hipertensión pulmonar en lactante asociada a pulmón en herradura: caso clínico

Relatamos caso de lactente jovem com desconforto respiratório precoce e hipertensão pulmonar, diagnosticado como variante de pulmão em ferradura, e revisamos literatura a cerca desta rara malformação pulmonar e suas repercussões cardíacas e hemodinâmicas.

This is the case report of a young infant with early respiratory distress and pulmonary hypertension, diagnosed as a variant of horseshoe lung and we have reviewed the literature to seek information about this rare pulmonary malformation and its cardiac and hemodynamic repercussions.

Se presenta un caso de una lactante joven con dificultad respiratoria precoz y la hipertensión pulmonar, diagnosticada como una variante de pulmón en herradura y revisamos literatura acerca de esta rara malformación pulmonar y sus repercusiones cardiacas y hemodinámicas.

Intervenções percutàneas no pós-operatório tardio de cirurgia de correção atrial para transposição das grandes artérias / Cardiac interventions in the late folow-up of atrial repair for transposition of the great arteries

A obstrução dos túneis intra-atriais no pós-operatório tardio de cirurgia de correção atrial para o tratamento da transposição das grandes artérias, não é uma complicação infrequente, podendo até, em alguns casos, ser fatal. O tratamento cirúrgico de tais lesões pode apresentar altos índices de morbidade e mortalidade. Recentemente, o tratamento percutâneo mediante implante de stent ou por meio de angioplastia com cateter-balão tem sido utilizado com bons resultados. Relatamos dois casos de tratamento percutâneo de obstrução dos túneis intra-atriais sistêmico e pulmonar.

Obstruction of the venous pathways after atrial repair fortransposition of the great arteries is not uncommon and can be, in some cases, fatal. The surgical treatment of these complications is a high-risk procedure. Nowadays, percutaneous balloon angioplasty or stenting have been used with good results. We report two cases of percutaneous treatment of systemic and pulmonary "baffle" obstructions.

Tratamento cirúrgico da coarctação da aorta: experiência de três décadas / Surgical treatment of the aortic coarctation: three-decade experience

Objetivo: Revisar os resultados imediatos de 30 anos da cirurgia de coarctação da aorta (CoAo), no período entre 1974 e 2004. Foram incluídos todos pacientes operados de CoAo, isolada ou associada a outros defeitos congênitos. Método: Foram pesquisados...

Surgical treatment of the aortic coarctation: three-decade experience.

OBJECTIVE: To make a 30-year review of the immediate results of coarctation of the aorta (CoAo) operation, between 1974 and 2004. All the patients underwent CoAo whether in isolation or associated with other congenital defects. METHODS: The following data was investigated: age at the time of surgery, gender, associated lesions, and type of surgical technique, and immediate surgical outcome, particularly focusing the presence of systemic arterial hypertension. RESULTS: One hundred and four patients underwent CoAo. Of the 104 enrolled patients, 75 (72%) were pediatric patients and 29 (28%) adults patients. In the pediatric group, 23 (22%) were considered neonates, 17 (16%) infants, and 35 (34%) children. The associated defects were present in 66 (63.5%) patients, 54 (51.9%) in the pediatric group and 12 (11.3%) in the adult group. Seven (6.7%) deaths were observed in the immediate postoperative period. Among the various surgical techniques employed, aortoplasty was used in 80 patients (76.9%); end-to-end anastomosis in 15 (14.4%); Teles technique in seven (6.7%), Waldhausen technique in one (1%), and it was not possible to identify the technique in one patient (1%). CONCLUSIONS: Despite the limitations of the present study, it may be noted that the results were good with the corrective surgery being performed safely and with a low mortality rate. Medium- and long-term follow-up was impaired by the well-known structural deficiencies in Brazil.

Endoarterite infecciosa pós-coarctaçäo de aorta em menino de 11 anos / Infectious Endoarteritis After Aortic Coarctation in an Eleven-Year-Old Boy

The authors describe an unusual case of infectious endo-arteritis after aortic coarctation. Clinical and echocardiographic aspects and the excellent surgical results are enhanced

Os autores descrevem um caso infreqüente de endoarterite infecciosa pós-coarctação de aorta em um menino de 11 anos de idade. Peculiariedades do quadro clínico, o aspecto ecocardiográfico e o excelente resultado cirúrgico são destacados

O uso da DL-Carnitina como proteçäo miocárdica na difteria / Use of DL-Carnitina as miocardic protection in diphteria

Visando avaliar o valor da DL-Carnitina (DLC) como protetor contra a açäo da toxina diftérica sobre o miocárdio, foram estudados prospectivamente 186 pacientes diftéricos internados no Isolamento Infantil do Hospital Oswaldo Cruz, no período de janeiro a dezembro de 85. Os pacientes foram submetidos ao tratamento tradicional (antibióticos e SAD) e divididos aleatoriamente em 2 grupos DLC-90 pacientes que usaram a droga, e grupo controle-96 pacientes que näo a usaram. Os 2 grupos similares quanto a idade, sexo, v acina prévia e tempo início sintomas - ínicio tratamento. No grupo DLC surgiram 9 casos de miocardite, sendo um discutível, motivo pelo qual foi excluído (paciente foi a óbito por provável sepsis e insuficiência repiratória). Dos 8 casos considerados (8,8%) 7 foram de miocardite leve e um de miocardite grave, todos com recuperaçäo total sem seqüelas. No grupo controle surgiram 16 casos de miocardite, dois dos quais discutíveis e que foram excluídos. Dos 14 considerados (14,6%) 6 foram de miocardite leve (todos recuperados sem seqüelas) e 8 de miocardite grave dos quais 7 foram a óbito e um sobreviveu, porém com seqüela importante (fibrose miocárdica com insuficiência cardíaca grau funcional II com medicaçäo). A diferença na incidência de miocrdite nos dois grupos näo foi significante. Entretanto, se considerarmos o número de casos graves e de óbitos, a diferença teve significância estatística (p < 0,05). Os autores concluem que embora reconheçam a necessidade de mais estudos, o uso da DLC na difteria parece conferir proteçäo miocárdica contra a açäo da toxina ciftérica