Minimally Invasive Concomitant Aortic And Mitral Valve Surgery - Initial Experience Of A Single Centre.

INTRODUCTION: Valve surgery through a median sternotomy has been the standard approach, but in the past decade various minimally invasive procedures have gained increasing traction among physicians and patients. MATERIALS AND METHODS: We present a series of three patients submitted to minimally invasive combined aortic and mitral valve surgery, performed through right lateral thoracotomy. RESULTS: We report no postoperative complication or mortality. Mean length of stay was 5 days, with a self-reported pain score 2/5 (mild/annoying pain). CONCLUSIONS: We report our initial experience, describing surgical technique and postoperative results, showing this technique to be safe, reproductible and comparable to conventional surgery.

Tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis.

BACKGROUND: Concomitant tricuspid repair in MR surgery is indicated in patients with severa tricuspid regurgitation, however, concomitant repair in less-than-severe TR patients is still a matter of debate. METHODS: In December 2021, we systematically searched PubMed, Embase and Cochrane databases for randomised control trials (RCTs) comparing isolated MR surgery versus MR surgery with concomitant TR annuloplasty. Four studies were included, resulting in 651 patients (323 in the prophylactic tricuspid intervention group and 328 in the no tricuspid intervention group). RESULTS: Our meta-analysis showed a similar all-cause mortality and perioperative mortality for concomitant prophylactic tricuspid repair when compared with no tricuspid intervention (pooled odds ratio (OR), 0.54; 95% confidence interval (CI): 0.25-1.15, P = 0.11; I2 = 0% and pooled OR, 0.54; 95% CI: 0.25-1.15, P = 0.11; I2 = 0%, respectively) in patients undergoing MV surgery. despite a significantly lower TR progression (pooled OR, 0.06; 95% CI: 0.02-0.24, P < 0.01; I2 = 0%). Additionally, similar New York Heart Association (NYHA) classes III and IV were identified in both concomitant prophylactic tricuspid repair and no tricuspid intervention, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI: 0.38-1.06, P = 0.08; I2 = 0%). CONCLUSIONS: Our pooled analyses suggested that TV repair at the time of MV surgery in patients with moderate or less-than-moderate TR did not impact on perioperative or postoperative all-cause mortality, despite reducing TR severity and TR progression following the intervention.

VIDEO-ASSISTED THORACOSCOPIC SURGERY WITHOUT CHEST DRAIN PLACEMENT.

BACKGROUND: Placement of chest drain following thoracoscopic procedures has been the gold standard. Nevertheless, a drainless approach may be safe and feasible in selected patients and procedures. In this study we aim to report our clinical experience after drainless video-assisted thoracoscopic surgery. METHODS: We retrospectively analyzed data of all subjects submitted to drainless video-assisted thoracoscopic surgery at our centre between January 1, 2010 and December 31, 2019. The preoperative clinical and surgical data and the immediate postoperative data were retrospectively evaluated through the consultation of the clinical processes and the computer registry system. We used descriptive statistics: mean or median, according to data distribution, and absolute or relative frequencies. RESULTS: We included 161 patients, mean age of 31 years (min:15; max:78). We analyzed data from patients submitted to: thoracic sympathectomy(67.1%), wedge resection, for lung biopsy, metastasis or small nodules resection (21.7%), mediastinal cysts removal (6.2%), pleural lesions resection (3.7%) and emphysematous bullae resection (1.2%). The average length of stay was 1 day. Residual pneumothorax was noted in 15 patients (9.3%). Postoperative pleural drain placement due to pneumothorax occur in 4 patients (2.5%). There was no intra-hospitalar mortality. CONCLUSIONS: Video-assisted thoracoscopic surgery without postoperative chest drain seems to be valid and safe according to our results.

Cerebral embolism due to left atrial myxoma in a patient presenting with chest pain and ST-segment elevation: a case report.

BACKGROUND: Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms. In acute myocarditis, chest pain (CP) may mimic typical angina and also be associated with electrocardiographic changes, including an elevation of the ST-segment. A large percentage (20-56%) of myxomas are found incidentally. CASE SUMMARY: A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour. DISCUSSION: Myocarditis can have various presentations may mimic acute myocardial infarction and CMR is critical to establish the diagnosis. Myxoma with embolic complications requires emergent surgery. To the best of our knowledge, this is the first case reported in the applicable literature of a myxoma diagnosed during a myocarditis episode.

Acute Prosthetic Aortic Valve Obstruction Leading to Free Aortic Insufficiency Veno-Arterial Extracorporeal Membrane Oxygenation as a bridge to surgery.

INTRODUCTION: Mechanical prosthetic valve thrombosis (PVT) and obstruction is a lifethreatening event. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation and treatment. CASE REPORT: A 66-year-old female patient with a history of aortic valve replacement 13 years before, was admitted to our intensive cardiac care unit with symptoms and signs of prosthetic aortic valve dysfunction. During cardiac angiography, she collapsed and fluoroscopy showed an immobile disc, stopped in an open position and causing free aortic regurgitation. Cardio-pulmonary resuscitation (CPR) was initiated and a VA-ECMO was inserted as a bridge to emergent cardiac surgery. Surgery was then performed and the patient was successfully discharged with no neurological impairment. DISCUSSION: We present a case where Veno-Arterial Extracorporeal Membrane Oxygenation (VA- ECMO) was successfully used as a bridge to emergent surgery in a cardiac arrest patient due to prosthetic valve thrombosis. CONCLUSIONS: This case illustrates how a relative contraindication (severe aortic insufficiency) to VA-ECMO may, in the end, be an indication in a very particular scenario.

[Papillary muscle rupture as a manifestation of SLE in the puerperium]. / Rotura de Músculo Papilar como Manifestação de Lupus Eritematoso Sistémico no Puerpério.

Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS) are two autoimmune diseases that may have serious cardiovascular manifestations, especially when associated. We report the clinical case of a young female, in the puerperium, with SLE in acute phase, who developed a sudden heart failure due to rupture of the papillary muscle. She underwent emergent cardiac surgery, with replacement of the mitral valve by a biological prosthesis. The postoperative course had no major intercurrences. Catastrophic SAF was concluded as a final diagnosis, due to the presence of anti-phospholipid antibody, to the attainment of multiple organs by thromboembolic phenomena, with histological documentation of micro-thrombi in cardiac tissue. This condition has a mortality rate of about 50%, despite treatment.

O Lúpus Eritematoso Sistémico (LES) e a Síndrome Antifosfolípido (SAF) são duas doenças auto-imunes que podem ter manifestações cardiovasculares graves, principalmente quando associadas. Apresentamos o caso clínico de uma doente jovem, puérpera, com LES em fase de agudização, que desenvolveu um quadro súbito de insuficiência cardíaca grave, por ruptura de músculo papilar. Foi submetida a cirurgia cardíaca emergente, com substituição da válvula mitral por prótese biológica. O período pós-operatório decorreu sem intercorrências de relevo. Como diagnóstico final concluiu-se SAF catastrófica, devido à presença de anticorpo anti-fosfolípido, ao atingimento de múltiplos órgãos por fenómenos trombo-embólicos, com documentação histológica da presença de micro-trombos no tecido cardíaco. Esta condição tem uma taxa de mortalidade de cerca de 50%, apesar do tratamento.

Aortic Valve Replacement With Perceval® Bioprosthesis: Initial Single-Center Experience.

INTRODUCTION: Aortic valve replacement (AVR) is the gold standard for the treatment of severe or symptomatic aortic valve stenosis. Less invasive procedures have been developed as an alternative to the conventional technique of full sternotomy approach with stented prosthesis. The Perceval® aortic valve (LivaNova, Milan, Italy) is a sutureless bioprosthesis, of which several reports have shown promising results in terms of mortality, morbidity and hemodynamic performance, especially with a less invasive approach. METHODS: Between March 2016 and September 2017, 43 patients underwent AVR with Perceval® bioprosthesis. The mean age was 74.3±6.8 years, 24 (55.8%) patients were female, and the mean EuroSCORE II was 4.1±0.6. Concomitant procedures were CABG (n=11; 25.6%), mitral valve surgery (n=2; 4.7%) and tricuspid valve surgery (n=1; 2.4%). RESULTS: Isolated AVR were performed in 31 patients (72%), with a less invasive approach in 29 cases (67%), of which 20 patients with upper ministernotomy and 9 patients with right anterior mini-thoracotomy. Cardiopulmonary bypass and cross- clamp times were 69.8±26.6 and 49.2±18.1 minutes for isolated AVR and 106.1±32.6 and 82.9±24.9 minutes for combined procedures, respectively. Preoperative peak and mean gradients were 81.6±24.8 and 49.7±16.1 mmHg, decreasing to 22.4±10.2 and 11.9±5.8 mmHg, respectively, during follow up (mean 9.1±6.0 months). The mean effective orifice area improved from 0.77±0.18 to 1.83±0.45 cm2, and mean left ventricular ejection fraction from 55.0±10.0 to 55.2±8.4%; mean left ventricular mass decreased from 221.6±55.7 to 180.2±42.4 g/m2. Trivial paravalvular leakage occurred in 2 patients, without clinical relevance. Five patients (11.6%) needed pacemaker implantation because complete heart-block before discharge (in 4 patients postdilation modelling wasn't performed). In-hospital mortality was 9.3% (n=4), all non-valve related (mean EuroSCORE II of 9.15±4.0). CONCLUSION: AVR with the Perceval bioprosthesis is associated with low mortality rates and excellent hemodynamic performance. Sutureless technology may reduce operative times, especially in combined procedures, making minimally invasive AVR more easily reproducible.

[Coordination of care for people living with HIV/AIDS in a city in São Paulo State, Brazil.] / Coordenação da assistência prestada às pessoas que vivem com HIV/AIDS em um município do Estado de São Paulo, Brasil.

The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.

Coordenação da assistência prestada às pessoas que vivem com HIV/AIDS em um município do Estado de São Paulo, Brasil / Coordination of care for people living with HIV/AIDS in a city in São Paulo State, Brazil / Coordinación de la atención a personas que viven con VIH/SIDA en un municipio del estado de São Paulo, Brasil

Objetivou-se analisar a coordenação das ações e serviços de saúde na assistência às pessoas que vivem com HIV/AIDS. Trata-se de um estudo seccional com 301 pessoas que vivem com HIV/AIDS. A análise foi feita por técnicas descritivas, analise de variância e comparação múltiplas de médias. Encontrou-se que a coordenação da assistência foi satisfatória (média = 3,69 e DP = 1,74). As pessoas que vivem com HIV/AIDS utilizavam outros serviços de saúde além dos Serviços de Assistência Especializada em HIV/AIDS – SAE (Pronto Atendimento: 67%; atenção básica: 43,2%; outros serviços especializados: 23,6%; serviços privados: 15%). Os cinco SAE apresentaram diferentes desempenhos, bem como distintos contextos e composições assistenciais, entretanto adequado manejo dos aspectos clínicos em detrimento dos sociais. O fornecimento da guia de referência foi tido como satisfatório, entretanto a guia de contrarreferência insatisfatório. Há necessidade de estratégias que favoreçam o desenvolvimento de ações compartilhadas e cooperadas dentro das equipes dos SAE e entre os diferentes serviços com o intuito de fortalecer a produção de cuidado resolutivo.

The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.

Este estudio tuvo como objetivo analizar la coordinación de acciones y servicios de salud en la asistencia a personas que viven con VIH/SIDA. Se trata de un estudio transversal con 301 personas que viven con VIH/SIDA. El análisis se realizó mediante técnicas descriptivas, análisis de varianza y comparación múltiple de medias. Se descubrió que la coordinación de la asistencia fue satisfactoria (media = 3,69 y SD = 1,74). Las personas que viven con el VIH/SIDA cuentan con otros servicios de salud más allá de los Servicios de Apoyo Especializados en VIH/SIDA con los siguientes porcentajes de uso: SAE (atención en urgencias) 67%; atención primaria 43,2%; servicios especializados 23,6%; y privados 15%). Los cinco SAE evidenciaron diferentes actuaciones que se traducen en diversas formas de cuidado, así como en la gestión adecuada del tratamiento clínico en su faceta social. La provisión de una guía de referencia se consideró satisfactoria, incluso frente a la lucha contra elementos insatisfactorios. Es necesario desarrollar estrategias que fomenten el impulso de acciones comunes y coordinadas dentro de los equipos de SAE y entre los diferentes servicios existentes, con el fin de fortalecer decisivamente la atención en la salud dentro de este ámbito.

[Giant tumoral lesion in the left atrium: an uncommon case of undifferentiated cardiac sarcoma]. / Lesão tumoral gigante na aurícula esquerda: um caso incomum de sarcoma cardíaco indiferenciado.

Primary cardiac tumors are rare, with an incidence ranging from 0.0001% to 0.030%; 80% are benign, while sarcomas account for 95% of malignant tumors. The authors report the case of a 75-year-old patient with a giant mass in the left atrium. The final diagnosis was of an undifferentiated cardiac sarcoma. This tumor represents a real challenge not only for timely diagnosis, but especially the therapeutic approach to adopt.

O aconselhamento para realização da sorologia anti-HIV em gestantes / Counseling for the realization of anti-HIV serology among pregnant women

Introdução: devido à importância do número de casos de aids entre mulheres e o consequente aumento da transmissão materno-infantil, o município de Ribeirão Preto/SP instituiu em 1996 o "Protocolo de oferecimento da sorologia anti-HIV no pré-natal com aconselhamento pré e pós-teste" em toda rede básica de saúde. Objetivo: contextualizar como se dá o processo de aconselhamento na percepção de enfermeiros e médicos ginecologistas. Métodos: como referencial teórico utilizamos o conceito de vulnerabilidade e no metodológico utilizamos a análise de prosa de André (1993), pós-realização de grupos focais. O tópico explorado foi o aconselhamento. Resultados: Foram extraídos dois núcleos temáticos: aconselhamento e processo de trabalho. No aconselhamento emergiram subtemas: o caráter voluntário do teste anti-HIV; a percepção de risco; a quebra da cadeia de transmissão e os sentimentos mobilizadores frente ao HIV/aids. No núcleo temático processo de trabalho foram gerados os subtemas: planejamento das ações nas unidades de saúde e recursos humanos em saúde. Levamos em consideração as múltiplas dimensões da prática do aconselhamento frente ao modelo assistencial vigente e à subjetividade dos atores envolvidos. Conclusão: apesar de todo o avanço no campo científico e tecnológico, a aids continua sendo uma doença que mobiliza muitos sentimentos, entre eles medo, confusão, desinformação e discriminação. Ficou evidente a necessidade de se priorizar temas transversais como sexualidade e drogas na formação destes profissionais, marcador indelével deste estudo. Para melhorar a qualidade da assistência usando a estratégia do aconselhamento serão necessárias reflexões e análises da prática do aconselhamento, sob a ótica da relação profissional de saúde/usuário, visando a sensibilização para a necessidade de mudança no modo de fazer o trabalho em saúde.

Introduction: due to the large number of cases of aids among women and the consequent increase in mother-to-child transmission, the city of Ribeirão Preto - SP established in 1996 the "Protocol to offer of anti-HIV testing in prenatal advice on pre and post-test" in all core network of health. Objective: to discuss the process of counseling in the perception of nurses and doctors gynecologists. Methods: the concept of vulnerability was used as theoretical reference and Analisis of Prose, André (1993), was used as the methodology post-execution of focus groups. The topic explored was counseling. Results: we extracted two thematic groups: counseling and work process. In counseling emerged the sub themes: the voluntary character of HIV test; perception of risk; breaking the chain of transmission and feelings facing the HIV/aids. At the core thematic work process, were generated the sub themes: planning ofactions in units of health and human resources in health. We took into account the multiple dimensions of the practice of counseling based on the existing care model and subjectivity of the actors involved. Conclusion: despite all the progress in scientific and technological s, aids remains a disease that mobilizes many feelings, such as fear, confusion, misinformation and discrimination. The need to prioritize cross-cutting themes such as sexuality and drugs in the training of these professionals was evident. To improve the quality of care using the strategy of counseling necessary with reflection and analysis of practical counseling, from the perspective of the relationship of health professional-patient, aimed at raising awareness of the need to change in the way ofdoing the work in health.

O conhecimento de jovens universitários sobre AIDS e sua prevenção / Young academic knowledge about aids and its prevention / El conocimiento de los jóvenes universitarios sobre sida y su prevención

A Aids é um grave problema de Saúde Pública, pois a cada ano aumenta o número daqueles que se contaminam. No Brasil a transmissão heterossexual tornou-se a principal via de contágio do HIV. Objetivo: levantar junto a jovens de 17 a 24 anos que cursam o terceiro grau, os conhecimentos sobre a Aids e sua prevenção. Metodologia:pesquisa desenvolvida em uma universidade privada do interior do estado de São Paulo, com alunos de ambos os sexos dos cursos de Pedagogia, Jornalismo, Moda e Turismo. Foi aplicados 300 questionários com perguntas abertas e fechadas no período de fevereiro a abril de 2006. Resultados: 95% dos alunos conhecem a doença e o modo de transmissão;66% disseram usar o preservativo masculino e 26% não ou depende e o motivo alegado é parceiro fixo, casamento, confiança no parceiro. Quanto à dificuldade para usar o preservativo 60% disseram não ter nenhuma, mas, 50 % relatam dificuldades como: colocação, perda de sensibilidade, entre outros. Apenas 2% dos alunos já usaram o preservativo feminino. Para 57% dos entrevistados, a palavra Aids lembra morte, sofrimento e dor.

Aids is a serious problem of Public Health, because each year rises the number of contaminated persons. In Brazil, heterosexual transmission became the main way of infection by HIV. Goal: to know, how adolescents, in the age-group of 17 to 24 years old that attend to the third degree school pattern, know about Aids and its prevention. This research was developed on a private university in the state of São Paulo, Brazil, interviewing students, from courses: journalism, fashion, tourism pedagogy. We applied 300 questionnaires with openned and closed questions in the period from february to april of 2006. Results: 95% of students has a knowledge of Aids and the way of its transmission. As for the use of preservatives, 66% said they use them and 26% do not use them and the alleged motive are: stable partner, marriage. As for to the difficulty to use preservatives 60% said they have no problems, but 50% reported difficulties to put them on, lost of sensibility, tightness, among others. Only 2% of students used the feminine preservatives. To 57% of the interviewed students, the word Aids remembers death, suffering and pain.

SIDA es un grave problema de Salud Pública, pues a cada año aumenta el número de aquellos que se contaminan. En Brasil la transmisión heterosexual es la principal forma de contagio del HIV. Aunque haya muchas campañas enfatizando la prevención de SIDA, el número de jóvenes e especialmente de mujeres sigue aumentando. Objetivo: fue relevar junto a jóvenes de 17 a 24 años que cursan el tercer grado, los conocimientos sobre SIDA y su prevención. La investigación fue desarrollada en una universidad particular del interior del estado de São Paulo, con alumnos de ambos los sexos de los cursos de Periodismo, Moda, Turismo, Pedagogía. Fueron aplicados 300 cuestionarios con preguntas abiertas y cerradas en el período de febrero a abril de 2006. Resultados: 95 % de los alumnos conocen la enfermedad y el modo de transmisión. Cuanto a usar el preservativo, 66% dicen que sí y 26% no o depende, siendo los motivos pareja fija, matrimonio. Cuanto a la dificultad para usar el preservativo, 60% dijeron no tener ninguna, pero 50% relatan dificultades: colocación, pérdida de sensibilidad, entre otros. Apenas 2% de los alumnos ya usaron el preservativo femenino. Para 57% la palabra SIDA significa muerte, sufrimiento y dolor.

HIV prevalence and risk factors in a Brazilian penitentiary

A infecção pelo HIV em presidiários alcança uma das maiores prevalências entre subgrupos populacionais específicos, com taxas de até 17 por cento, já tendo sido descritas no Brasil e no mundo. Esta pesquisa objetivou estimar a prevalência do marcador do HIV e fatores de risco para essa infecção na população masculina carcerária da Penitenciária de Ribeirão Preto, São Paulo, Brasil, no período de maio a agosto de 2003. Do total de 1.030 presidiários, foram sorteados 333 participantes por amostragem aleatória simples, os quais foram submetidos à aplicação de um questionário padronizado e coleta de sangue. Para diagnóstico sorológico do HIV foi utilizado o ensaio imunoenzimático (ELISA) e reação de imunofluorescência indireta. A prevalência global do HIV nos presidiários foi de 5,7 por cento (IC95 por cento: 3,2-8,2). Todas as variáveis que mostraram associação com presença do anti-HIV, por meio de análise univariada, foram submetidas a modelo multivariado de regressão logística não condicional. As variáveis que se mostraram preditoras de forma independente da infecção pelo HIV foram: tempo total da pena a ser cumprida inferior a cinco anos e compartilhamento de agulhas e seringas.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17 percent in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7 percent (95 percentCI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

HIV prevalence and risk factors in a Brazilian penitentiary.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

[Early migration of the device for transcatheter closure of atrial septal defect. Case report]. / Migração precoce de dispositivo para encerramento percutaneo de comunicação inter auricular. Caso clinico.

The transcatheter closure of the atrial septal defect (ASD) has been proposed as an alternative to surgical therapy for the ostium secundum ASD. It is considered an effective and safe procedure, although rare but potentially fatal complications have been reported. The authors report a case of early migration of a device for transcatheter closure of an ASD to the right pulmonary artery.

[Carney's Complex: familial cardiac myxoma]. / Complexo de Carney: mixoma cardíaco familiar.

The Carney Complex is a very rare autosomal dominant disease including multiple neoplasia syndrome. This syndrome was initially described in 1985 under the rubric "...the complex of myxomas, spotty pigmentation, and endocrine overactivity". We present a case report of an old woman with Carney Complex who had the characteristic features of facial hirsutism and acromegalic facies, a large pigmented swelling over the face and a cardiac myxoma arising from the left atrium. We emphasize the need for periodic echocardiographic screening of patients and family members.