Normalization of left ventricular dysfunction in systemic hypertension.

BACKGROUND: In hypertensive heart disease, it is uncertain whether the impairment of left ventricular (LV) systolic function might be reverted by antihypertensive treatment. HYPOTHESIS: This study was undertaken to address the likelihood of recovery of LV dysfunction and to identify factors potentially related. METHODS: Twenty-six patients with primary (n = 16) and renovascular (n = 10) hypertension participated in the study and were classified into Groups A (n = 12) and B (n = 14) according to normalization or persistent left ventricular dysfunction (fractional shortening < 0.30) after 36 weeks of follow-up. All patients received standard medical therapy and appropriate procedures for renovascular disease correction. Logistic regression analysis was used to identify variables associated with recovery. RESULTS: Patients in Group A compared with those in Group B were younger (41 +/- 14 vs. 52 +/- 10 years; p < 0.05), had a greater frequency of renovascular hypertension (8 vs. 2; p < 0.05), showed shorter LV end-diastolic (54 +/- 5 vs. 61 +/- 8 mm; p < 0.05) and end-systolic dimensions (41 +/- 6 vs. 49 +/- 9 mm; p < 0.05), and lower mass index (215 +/- 64 vs. 261 +/- 47 g.m-2; p < 0.05) before treatment, whereas fractional shortening (0.24 +/- 0.4 vs. 0.20 +/- 0.5; p > 0.05) and diastolic blood pressure (116 +/- 12 vs. 122 +/- 19 mmHg; p > 0.05) were similar. On follow-up, Group A patients showed lower diastolic blood pressure (89 +/- 15 vs. 105 +/- 20 mmHg; p < 0.05) and mass index (142 +/- 34 vs. 222 +/- 40 g.m-2; p < 0.05). Logistic regression analysis identified systolic dimension and renovascular hypertension as factors associated with fractional shortening normalization. CONCLUSION: The recovery of LV dysfunction is expected to occur most likely in patients with renovascular hypertension and the shortest systolic dimensions.

Huesos suturales en el pterion / Sutural bones in the pterion

Las variaciones de los huesos del cráneo son de interés para la anatomía, antropología física, imagenología y medicina legal. Con el propósito de aportar mayores detalles sobre los huesos suturales que se presentan en el pterion, fueron analizados 205 cráneos secos de individuos brasileños, adultos, de ambos sexos, blancos y no blancos. El hueso sutural fue observado en 31 cráneos (15,1 por ciento), localizándose 19 en el lado derecho (61,3 por ciento), 8 en el izquierdo (25,8 por ciento) y 4 en ambos lados (12,9 por ciento. Con relación al sexo, 14 estuvieron presentes en cráneos masculinos (45,2 por ciento) y 17 en femeninos (54,8 por ciento). En relación al grupo étnico, 20 eran del grupo blancos (64,5 por ciento) y 11 de no blancos (35,5 por ciento). Las articulaciones de este hueso sutural con los huesos vecinos fueron clasificados en 4 tipos: tipo I, donde se articuló con los huesos frontal, parietal, ala mayor del esfenoides y temporal, disposición encontrada en 17 cráneos (54,8 por ciento); tipo II, donde se articuló con el parietal, temporal y ala mayor del esfenoides, encontrado en 11 cráneos (35,5 por ciento); tipo III, donde se articuló con el temporal, frontal y ala mayor del esfenoides, observado en 2 cráneos (6,5 por ciento) y tipo IV, donde se articuló con el parietal, frontal y ala mayor del esfenoides, encontrado en 1 cráneo (3,2 por ciento). Correlacionando las variables lado, sexo, grupo étnico y hueso sutural, el análisis estadístico reveló que la presencia de estos huesos es significativa en los individuos blancos y en el lado derecho

Characteristics of the palatine mucosa of the calomys callosus: light and sem study

Se estudiaron las características de la superficie e interfase del tejido epitelio-conjuntivo de la mucosa palatina del paladar duro del Calomys callosus, a través del microscopio de luz y de la microscopía electrónica de barrido. Seis ejemplares fueron fijados en soluciones de Bouin y de Kamovsky modificada. Los resultados mostraron que las regiones anterior y media presentan pliegues transversales y superficies planas adyacentes. La superficie mostraba un epitelio escamoso queratinizado. La lámina propia de la mucosa palatina presentaba abundante tejido conjuntivo papilar de variadas formas. Próximo a la región de los dientes, el tejido conjuntivo papilar era más abundante. El pliegue transversal medía entre 150 µm y 300 µm de diámetro. La superficie de la mucosa palatina del paladar duro del Calomys callosus presentaba células epiteliales poligonales. Algunas células descamativas se notaban claramente. La superficie de la interfase del tejido epitelio-conjuntivo presentaba abundante tejido conjuntivo papilar primario y secundario. La red de gruesos haces de fibras colágenas se observaban en cada papila, mostrando imágenes tridimensionales

[Risk factors of stroke in carotid endarterectomy]. / Fatores de risco de acidente vascular cerebral na endarterectomia de carótida.

In order to find risk factors of carotid endarterectomy related stroke (CERS), 102 consecutive carotid endarterectomies, performed within two years on 95 patients were analyzed. Age, sex, diabetes, smoking, hypertension, degree of the operated and non operated carotid stenosis, previous neurological symptoms, anesthesia, protamine, cerebral monitoring, shunt, patch, post op. hypertensive crisis and clamping time were compared with the incidence of CERS. Four patients had major neurological deficits, two of which were fatal (3.92%). Six patients had minor transitory neurological deficit (5.8%). The use of patch and a long clamping time were the only identifiable statistically significant factors (p = 0.016 and p = 0.0053 respectively) that increase the odds of a CERS.

Exercise training and heparin pretreatment in patients with coronary artery disease.

The purpose of this study was to evaluate whether combined treatment with a cardiovascular exercise rehabilitation program and low doses of heparin can induce changes in ergometric parameters of ischemia in patients with coronary artery disease (CAD). Heparin may potentiate the development of new vessels promoted by ischemia and therefore may produce important clinical improvement. Thirty-six patients with stable CAD and evidence of myocardial ischemia on exercise testing were randomized into three groups: a control group (n = 11) received the usual medical treatment; another group (n = 11) underwent three exercise sessions per week during 12 weeks; and a third group (n = 14) undertook this exercise program and also received calcium heparin 12,500 IU subcutaneously 20 to 30 minutes before each exercise session. Pretreatment and posttreatment exercise tests were compared. Patients who underwent the rehabilitation program had an increase in exercise duration and workload at the onset of 1 mm ST-segment depression, but only patients who received calcium heparin showed a significant increase in rate-pressure product at the ST-segment ischemic threshold (p = 0.035). This result suggests that higher levels of myocardial oxygen consumption were now tolerated, a change that may be related to an improvement in myocardial perfusion.

[Percutaneous angioplasty and surgical revascularization in renovascular hypertension: experience in treatment and long-term follow up in 124 patients]. / Angioplastia percutânea e revascularização cirúrgica em hipertensão renovascular. Experiência no tratamento e seguimento de longo prazo em 124 pacientes.

PURPOSE: To report the experience in the treatment and long-term follow-up of patients with renovascular hypertension submitted to angioplasty and/or surgical revascularization, and to compare blood pressure and renal function responses to both treatment. METHODS: One hundred and twenty-four patients diagnosed with renovascular hypertension, divided, according to the etiology, as atherosclerosis (76 patients), fibromuscular dysplasia (32) and arteritis (16), were submitted to isolated or associated treatment of renal revascularization by percutaneous transluminal angioplasty (71 patients) or surgery (84). The patients were followed-up during 2.5 +/- 1.5 years and we evaluate blood pressure response and renal function preservation. In relation to blood pressure control, the patients were considered as cured when normotensives without antihypertensives, improved when normotensives with fewer drugs than previously, and unchanged, when out of these criteria. RESULTS: From 124 patients, 20% were considered cured, 54% improved and 26% unchanged, after a mean follow-up of 2.5 +/- 1.5 years. Patients with atherosclerosis and fibromuscular dysplasia presented a higher rate of care and improvement after surgery. The blood pressure and the number of antihypertensive drugs decreased significantly during the follow-up among patients that cured or improved arterial hypertension, either after angioplasty (190 +/- 26/115 +/- 14 mmHg vs 130 +/- 34/85 +/- 7 mmHg. 2.70 vs 1.60 drugs) or after surgery (194 +/- 17/115 +/- 16 mmHg vs 143 +/- 18 mmHg vs 88 +/- 8 mmHg, 1.88 vs 1.51 drugs). It was also observed a significant decrease of serum creatinine among these patients. CONCLUSION: Renal revascularization in patients with renovascular hypertension, either by angioplasty or surgery, is beneficial to control blood pressure and to preserve renal function in the majority of patients.

Mycotic aneurysm of the celiac trunk and superior mesenteric artery in a case of infective endocarditis.

Mycotic aneurysms of the celiac artery are extremely rare, and in our review of the literature we found that in only one case was it due to infective endocarditis. In our case a 19-year-old female patient with culture-negative infective endocarditis presented with pain in the epigastric area. A celiac artery aneurysm was diagnosed by ultrasonography and confirmed on CT scan and angiography, which also demonstrated an associated aneurysm of the superior mesenteric artery. Since excellent collateral circulation was present, simple ligation of the two aneurysms was performed. The patient presented no major complications in the postoperative course.

Teste de compressao das arterias femorais: metodo nao invasivo para deteccao de lesao obstrutiva de arteria iliaca interna / Femoral arteries compression test: a non invasive method for detection of obstructive injury of internal iliac artery

Para deteccao nao invasiva da presenca de doenca obstrutiva em arteria iliaca interna criou-se o teste de compressao das femorais. Este teste consiste na compressao da arcada inguinal com o polegar do examinador ate desaparecimento dos batimentos arteriais na regiao e distalmente no membro inferior correspondente, enquanto se ausculta o som na arteria dorsal peniana com estetoscopio ultra-sonico e se mede a pressao peniana. O teste foi considerado positivo quando houve abolicao do som na arteria peniana, ou reducao superior a 15 por cento na pressao peniana e, negativo, quando nao houve abolicao do som nem reducao da PP. Em 15 individuos normais, os 30 testes feitos, um para cada regiao inguinal, foram negativos. Em 23 pacientes com isquemia de membros inferiores selecionados pela analise de angiografias a que foram submetidos, foram realizados 39 testes, um em cada regiao inguinal em que havia batimento femoral. Houve abolicao do som na arteria dorsal peniana em 20 dos 22 testes em que a arteriografia mostrava obstrucao da arteria iliaca interna homolateral. Em 15 testes em que houve reducao da pressao peniana a arteriografia mostrava presenca de estenoses unica ou multiplas na arteria iliaca interna homolateral. Em dois casos com arteria iliaca interna homolateral pervia o teste foi negativo.

[Femoral artery compression test: a non-invasive method for detection of obstructive injury of the internal iliac artery]. / Teste de compressão das artérias femorais: método não invasivo para detecção de lesão obstrutiva de artéria ilíaca interna.

For non-invasive detection of obstructive disease in the internal iliac artery, the femoral compression test was devised. This test consists in the compression of the inguinal arcade of the patient with the examiner's thumb, until the disappearance of the arterial beats in this region and peripherically in the correspondent lower limb, while one auscultates the sound in the dorsal penial artery with ultrasonic stethoscope and measures the penial pressure. The test was considered positive when there was abolition of sound in the penial artery, or reduction superior to 15% in the penial pressure. The test was negative when there was no abolition or reduction of sound and pressure, as referred respectively. In 15 normal individuals the 30 tests, one for each inguinal region, were negative. In 23 patients with ischemia of lower limbs registered by the analysis of angiographies to which they were submitted, there were 39 tests, one in each inguinal region, in which there was femoral pulsation. There was abolition of sound in the penial dorsal artery in 20 of 22 tests in which the arteriography showed obstruction of the homolateral internal iliac artery. In 15 tests, in which there was reduction of penial pressure, the arteriography showed presence of unique or multiple stenosis in the internal homolateral iliac artery. In two cases of patency of the internal homolateral iliac artery, the test was negative. The positivity of the test was significantly higher in patients with obstructive lesions of internal iliac artery when compared to normal individuals (p < 0.001, chi-square test).(ABSTRACT TRUNCATED AT 250 WORDS)

Procedimento diagnostico-laboratorial para doentes com hemorragia acompanhadas em unidades de tratamento intensivo. / Diagnostic-laboratorial procedures for patients with hemorrhage followed-up in intensive care units

A puncao de uma polpa digital permite desenvolver os seguintes testes: tempo de sangramento, tempo de coagulacao, hemotocrito, dosagem de fibrinogenio e contagem de plaquetas.Esses testes podem ser feitos dentro de uma Unidades de Terapia Intensiva desde que ela esteja equipada com uma microcentrifuga, um banho maria a 56 graus C. e um microscopio de fase. Os resultados ficam prontos em ate 20 minutos e podem ser renovados a vontade. A interpretacao clinica dos resultados assim obtidos possibilita esclarecer se a causa de uma hemorragia esta relacionada a uma das seguintes condicoes purpura vascular depressao medular, coagulacao intravascular disseminada, politransfusao, desnutricao mecanica de plaquetas por circuitos extracorporeos, insuficiencia renal, acao de medicamentos antiagregantes de plaquetas, coagulopatia congenita, insuficiencia hepatica, hiperfibrinolise e uso de anticoagulantes

Arterias endarterectomizadas como substitutos vasculares na cirurgia reconstrutora aorto-iliaca e femoropoplitea. / Endarterectomized arteries as vascular substitutes in aorto-iliac and femoral-popliteal reconstructive surgery

Os autores apresentam 30 pacientes com doenca aterosclerotica oclusiva aorto-iliaca ou femoro-poplitea nos quais foram empregadas arterias autogenas endarterectomizadas como substituto vascular em situacoes incomuns. Dezenove pacientes tinham oclusao aorto-iliaca e onze obstrucao femoral. Dezesseis pacientes ja haviam sido operados nos correspondentes setores arteriais. Cinco pacientes tinham infeccao associada a proteses arteriais, dois apresentavam pseudo-aneurisma de linha de sutura e em 23 doentes havia apenas isquemia dos membros inferiores.Enxertos mistos com dacron ou veia safena foram utilizados em 17 operacoes, e nas 15 restantes se empregou apenas segmentos arteriais como enxertos. Os resultados foram bons, com apenas duas oclusoes das reconstrucoes e sem complicacoes locais. Tres pacientes falecerem por causas nao relacionadas com os substitutos vasculares empregados