Resultados de 5 anos da cirurgia bariátrica em pacientes com obesidade e hipertensão. um estudo clínico randomizado / 5-year outcomes of bariatric surgery in patients with obesity and hypertension. a randomized clinical trial

INTRODUÇÃO: Dados de estudos randomizados avaliando os efeitos a longo prazo da cirurgia bariátrica no controle e remissão da hipertensão (HTN) são escassos. O seguimento de curto e médio prazo do Estudo GATEWAY (1 e 3 anos) mostrou melhora significativa e remissão da hipertensão após a cirurgia bariátrica. Aqui, apresentamos os dados de acompanhamento de 5 anos deste estudo. MÉTODOS: Conduzimos um ensaio clínico randomizado, em um centro único, fase III, paralelo e aberto. Pacientes com obesidade graus 1 e 2, tomando no mínimo 2 medicamentos anti-hipertensivos em doses máximas para hipertensão, foram alocados aleatoriamente para Bypass gástrico em Y de Roux (RYGB) combinado com tratamento clínico (TC) ou TC (estilo de vida/aconselhamento nutricional) isoladamente. O desfecho primário foi a redução de pelo menos 30% do total de anti-hipertensivos, mantendo níveis controlados de pressão arterial (PA) <140/90mmHg. A análise principal seguiu o princípio de intenção de tratar modificada e os valores ausentes foram imputados com a técnica de imputação múltipla. Os desfechos secundários incluíram vários biomarcadores. RESULTADOS: Foram incluídos 100 pacientes (76% mulheres, idade: 43,8±9,2 anos, índice de massa corporal, IMC: 36,9±2,7Kg/ m2). Após 5 anos, o IMC foi de 27,8±3,8kg/m2 para RYGB e 36,4±3,9kg/m2 para TC (P<0,001). A análise de sensibilidade considerando apenas os casos com seguimento concluído (n=69) revelou resultados consistentes. Os desfechos secundários nos grupos RYGB e TC, aos 60 meses, foram: circunferência abdominal 88,05 ± 9,84cm e 109,44 ± 9,76cm (P<0,001) ; hemoglobina glicada 5,4 ± 0,43% e 5,96 ± 0,9% (P<0,001); insulina 6,41 ± 2,46mU/L e 24,65 ± 16,57mU/L (P<0,001); LDL colesterol 93.61 ± 31.06mg/dL e 109.94 ± 37.58mg/dL (P=0,022); triglicerídeos 86,76 ± 38,45mg/dL e 140,33 ± 59,11 mg/dL (P<0,001); proteína C reativa de alta sensibilidade 0,81 ± 0,76mg/L e 6,13 ± 6,22mg/L (P=0,005), respectivamente. CONCLUSÕES: A cirurgia bariátrica é uma estratégia eficaz e duradoura no controle da PA com menor número ou nenhum medicamento anti-hipertensivo e na melhora do perfil metabólico e inflamatório em pacientes com obesidade graus 1 ou 2 e hipertensão.

Characterization of Doppler spectrum of hepatic veins in dogs with pulmonary hypertension.

Pulmonary hypertension (PH) triggers hemodynamic changes within the right heart, which may affect hepatic venous flow. The aims of this study were three-fold: to investigate, prospectively, the reliability of the hepatic vein Doppler waveform to diagnose and characterize the magnitude of PH in dogs; to evaluate whether a correlation exists between hepatic venous flow waves and the structural and functional characteristics of the right ventricle (RV); and to determine whether age, gender, body weight, heart rate (HR), heart rhythm and systolic blood pressure affect the hepatic venous waveform pattern. A cross-sectional observational study was carried out in 43 dogs with varying degrees of PH and a control group of 15 healthy dogs. The velocities of the hepatic A, S, V and D spectral waves and the phasic pattern varied according to the severity of PH. Weak to moderate correlations were documented between hepatic vein waves and age, HR, and the structural and functional variables of the RV. A D Wave cut-off of 11.6 cm ∙ s-1 had a sensitivity of 100% and specificity of 35% for differentiation of dogs with severe PH from healthy dogs. Doppler assessment of hepatic venous flow was shown to be a reliable technique for screening dogs for PH.

Assessment of longitudinal systolic function using tissue motion annular displacement in dogs with degenerative mitral valve disease.

INTRODUCTION: Although degenerative mitral valve disease (DMVD) is essentially a disorder of the valve, the progression of the disease leads to structural myocardial changes that may compromise left ventricular systolic function. Tissue motion annular displacement (TMAD) is a surrogate for longitudinal fiber function based on speckle tracking assessment of the movement of the mitral annulus toward the apex during systole. The aim of this study was to evaluate longitudinal systolic function with TMAD in dogs with DMVD. ANIMALS: Ninety-four dogs with DMVD and 32 healthy dogs. METHODS: Prospective cross-sectional observational study. Dogs with DMVD of various American College of Veterinary Internal Medicine classification stages and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, as well as a standard and speckle tracking echocardiography. Global longitudinal strain (GLS) and TMAD were used to assess longitudinal systolic function. RESULTS: The global TMADmm and global TMAD% were higher in American College of Veterinary Internal Medicine B2 animals than in the stage CD. Global TMAD (mm/kg,mm/bodyweight3, mm/m2) were correlated with GLS and ejection fraction. Global TMAD (mm/kg,mm/m2,%) and GLS were influenced by sex. In addition, systolic blood pressure influenced GLS (P < 0.01; r = -0.23), global TMADmm/kg (P = 0.017; r = -0.21) and global TMADmm/m2 (P = 0.031; r = -0.19). Tissue motion annular displacement was fast to be performed and produced good repeatability in dogs with DMVD. CONCLUSIONS: Global TMAD (mm,%), was reduced in DMVD dogs with clinical signs of heart failure compared with stage B2. Tissue motion annular displacement was shown to be a repeatable technique for evaluation of longitudinal systolic function in dogs with DMVD.

T-wave peak-end interval and ratio of T-wave peak-end and QT intervals: novel arrhythmogenic and survival markers for dogs with myxomatous mitral valve disease.

INTRODUCTION/OBJECTIVES: In the past few years, novel markers such as the interval between the peak and the end of T-wave (Tpte) and Tpte/QT ratio have been shown to have high sensitivity for ventricular arrhythmias and mortality. We analyzed these and other parameters of ventricular repolarization, such as QT interval, QT interval corrected for heart rate (QTc), and QT dispersion (QTd) in dogs with myxomatous mitral valve disease (MMVD). Additionally, we investigated their relationship with the progression of the disease, echocardiographic parameters, and ventricular arrhythmias and assessed their prognostic value with development of clinical signs or mortality as the final outcome. ANIMALS, MATERIALS AND METHODS: Epidemiological, clinical, echocardiographic, and electrocardiographic data were obtained from 236 dogs with MMVD and 15 healthy dogs. Prognostic and survival information was also recorded for the MMVD group. All ventricular repolarization indices were measured in 10 lead electrocardiographic recordings. RESULTS: With the exception of the QT interval, most repolarization markers increased along with the frequency of arrhythmias and with the progression of MMVD. The parameters that best identified ventricular arrhythmias (AUC > 0.7) were Tpte (aVR, rV2, average rV2-V10, average rV2-V4) and Tpte/QT (II, aVR, rV2). In survival analysis, statistically significant markers with the highest differences in median survival were Tpte (maximum of any lead, maximum rV2-V10), QTc aVR, and Tpte rV2. CONCLUSION: Tpte and Tpte/QT are good non-invasive markers for clinical risk stratification in dogs with MMVD.

Assessment of right ventricular systolic function by tissue motion annular displacement in healthy dogs.

INTRODUCTION/OBJECTIVES: There are few parameters for assessment of right ventricular (RV) systolic function on echocardiographic examination. Morphofunctional studies are limited by the irregular shape of the RV. Recently, tissue motion annular displacement (TMAD), a technique that evaluates valve annulus displacement toward the cardiac apex, has shown a good correlation with left ventricular global longitudinal strain (GLS) in healthy dogs. Therefore, the aim of this study was to evaluate the longitudinal systolic function of the RV of healthy dogs using TMAD. ANIMALS: A hundred healthy client-owned dogs. MATERIALS AND METHODS: Cross-sectional study. Physical examination, electrocardiogram, blood pressure measurement, and echocardiography were recorded. The systolic function of the RV was evaluated by GLS free wall and TMAD. Data were compared with those derived from conventional echocardiography. RESULTS: TMAD values varied according to body weight. There was a correlation of TMAD in millimeters with all indices of RV systolic function, including GLS free wall (R:-0.239; p:0.017). TMAD had a correlation with age and heart rate; whereas there was no relationship with sex and blood pressure. The coefficient of variation for the intraobserver evaluation was lower for the TMAD in millimeters (9.9%) compared with the GLS free wall (17.9%). In addition, the mean time to perform TMAD (8.1 s) was lower than that of the GLS free wall (37.7 s). CONCLUSIONS: TMAD is a fast, reproducible, and promising method for assessing RV systolic function in healthy dogs. However, further studies are needed to understand the applicability of this technique in patients with heart disease.

Evaluation of echocardiographic variables of morphometry and function in horses submitted to minimally invasive partial pericardiotomy / [Avaliação de variáveis ecocardiográficas morfométricas e funcionais em cavalos submetidos à pericardiotomia parcial minimamente invasiva]

This study aimed to evaluate the impact of minimally invasive partial pericardiotomy on echocardiographic variables of morphometry and function in healthy horses. Minimally invasive pericardiotomy was performed in six healthy horses. Echocardiographic evaluation was executed in different moments: prior to the surgical procedure (M0); 24 hours post procedure (M1); 72 hours post procedure (M2) and 28 days post procedure (M3). The following variables were measured: Right ventricular internal diameter in diastole and systole (RVd and RVs), interventricular septum thickness in diastole and systole (IVSd and IVSs), left ventricular internal diameter in diastole and systole (LVd and LVs), left ventricular free wall thickness in diastole and systole (LVFWd and LVFWs), aortic root diameter (Ao) and left atrial diameter (LA). From this data, the following variables were calculated: fractional shortening (FS%), fractional thickening of the interventricular septum (IVS%), fractional thickening of the left ventricular free wall (LVFW%) and the relationship between left atrial and aortic diameters (LA/Ao). After 28 days, a new thoracoscopy was performed for inspection of the thoracic cavity. In M1 and M2 ECO evaluations, a statistically significant change in LVFW and a decrease in RVd, LVd, LVFWs, LA, LVs, FS% and IVS was documented. Pericardiotomy is a promising technique in horses, with minor postoperative complication. The variations in the echocardiographic parameters were transient and did not cause hemodynamic damage to the animals.(AU)

O objetivo do presente estudo foi avaliar o impacto da pericardiotomia parcial minimamente invasiva sobre as variáveis ecocardiográficas morfométricas e funcionais em cavalos, visto que não há nenhum trabalho que tenha avaliado o impacto da pericardiotomia na espécie equina. Foram utilizados seis cavalos hígidos, nos quais se realizou pericardiotomia minimamente invasiva. Em todos eles, foi efetuado exame ecocardiográfico em diferentes momentos: previamente ao procedimento cirúrgico (M0); 24 horas após (M1); 72 horas após (M2) e 28 dias após (M3). Foram mensurados: diâmetro interno do ventrículo direito (VDd e VDs), espessura do septo interventricular (SIVd e SIVs), diâmetro interno do ventrículo esquerdo (VEd e VEs), espessura da parede livre do ventrículo esquerdo (PLVEd e PLVEs), diâmetro interno da aorta (Ao) e diâmetro atrial esquerdo (AE). Foram calculadas as variáveis fração de encurtamento (FEC%), espessamento fracional do septo interventricular (SIV%), espessamento fracional da parede livre do ventrículo esquerdo (PLVE%) e relação entre diâmetro do átrio esquerdo e diâmetro aórtico (AE/Ao). Após 28 dias, realizou-se nova toracoscopia para inspeção da cavidade torácica. Nas avaliações do ECO no M1 e no M2, houve alteração estatisticamente significativa no PLVE em diástole (28±5,5 e 31,7±2, respectivamente) e diminuição dos parâmetros VDd,(30,1±11,6 e 31,7± 10,7) VEd (113,3±21 e 121,7±13,7), PLVEs (42±8,2 e 43,9±2,8), AE (78,5±6,1 e 82,7±4,7), VEs (74,1±16 e 71,5±9,3), FEC (34,4±10,2 e 41,2±5,7) e SIV (27,1±8,7 e 42,3±27,9). A técnica de pericardiotomia empregada mostrou-se promissora em equinos. As variações dos parâmetros ecocardiográficos foram transitórias, não causando prejuízos hemodinâmicos aos animais.(AU)

Correlação entre a deflexão intrinsecoide, classificação clínica e parâmetros ecocardiográficos em cães com degeneração mixomatosa valvar mitral / Correlation between intrinsecoid deflection, clinical classification and echocardiographic parameters in dogs with degenerative mitral valve myxomatosis

A degeneração mixomatosa valvar mitral (DMVM) costuma ser diagnosticada pelo ecocardiograma, porém o eletrocardiograma (ECG) pode sugerir alterações específicas e auxiliar no diagnóstico e no tratamento. A deflexão intrinsecóide (DI) é uma medida simples do ECG, que representa o início da despolarização ventricular e pode indicar a presença de sobrecargas e hipertrofia no ventrículo esquerdo. O objetivo deste trabalho é comparar dados prévios sobre condição clínica e ecocardiograma de cães com endocardiose de mitral e o valor da deflexão intrinsecóide do ECG, para buscar uma relação de concordância. Foram selecionados os arquivos de 45 cães anteriormente atendidos na rotina clínica do HV-UPFR. A estatística mostrou diferença relevante nos grupos B1, B2 e C nas derivações D2, D3, aVF, rV, V2 e V4 (P<0,05), o que permitiu classificá-los de acordo com o tamanho da DI, e esse resultado correspondeu à classificação do consenso de endocardiose de mitral em cães nesses estágios. Concluiu-se que há um aumento gradativo no valor da DI à medida que a DMVM avança, principalmente nos estágios B1, B2 e C, associado à sobrecarga e à hipertrofia ventricular esquerda, portanto esse parâmetro pode ser usado na classificação da doença.(AU)

The mitral valve myxomatous degeneration (DMVM) is usually diagnosed by echocardiography, however, electrocardiogram (ECG) may suggest specific alterations and aid diagnosis and treatment. Intrinsicoid deflection (DI) is a simple ECG measure that represents the onset of ventricular depolarization and may indicate the presence of overload and hypertrophy in the left ventricle. The objective of this study is to compare previous data on clinical condition and echocardiogram of dogs with mitral endocardiosis and the value of the intrinsicoid deflection from ECG to obtain a concordance relation. The archives of 45 previously examined dogs in the clinical routine of HV-UFPR were selected. The statistic showed a significant difference in groups B1, B2 and C in leads D2, D3, aVF, rV, V2 and V4 (P< 0,05), which allowed to classify them according to the DI size, and this result corresponded to the consensus classification of mitral endocardiosis in dogs at these stages. It was concluded that there is a gradual increase in the value of DI as DMVM progresses, especially in stages B1, B2 and C, associated with left ventricular overload and hypertrophy, so this parameter can be used to classify the disease.(AU)

Reliability of smartphone-based radiographic interpretation for evaluating cardiogenic pulmonary oedema in dogs.

OBJECTIVE: To compare the accuracy of radiological diagnosis of cardiogenic pulmonary oedema in dogs using two viewing platforms. MATERIAL AND METHODS: A retrospective cross-sectional study including cases admitted between January 2012 and December 2016. Thoracic radiographs from 121 dogs with and without cardiogenic pulmonary oedema were included. The study was divided into two phases, and images were interpreted by two observers: a radiologist (R1) and a cardiologist (R2). In the first phase, images were sent in JPEG format for interpretation using a smartphone. In the second phase, DICOM images were interpreted at the standard workstation using a DICOM viewer. Receiver operating characteristic curves were generated to evaluate the accuracy of each method of radiological evaluation, and Spearman correlation was used to evaluate the correlation between the evaluations performed by R1 and R2. RESULTS: The accuracy of R1 in diagnosing pulmonary oedema was 94.1% (95% confidence interval: 88.3 to 97.5) for DICOM images and 90.7% (95% confidence interval: 84.1 to 95.1) for JPEG/smartphone. The accuracy of R2 was 89.5% (95% confidence interval: 82.6 to 94.4) for DICOM images and 90.6% (95% confidence interval: 83.9 to 95.2) for JPEG/smartphone. There was no statistically significant difference between these evaluation methods. The correlation coefficient for R1 and R2 was 0.815 and 0.761, respectively. CLINICAL SIGNIFICANCE: Cardiogenic pulmonary oedema may be reliably diagnosed on thoracic radiographs viewed on a smartphone by a specialist, which may expedite treatment.

QT instability, an indicator of augmented arrhythmogenesis, increases with the progression of myxomatous mitral valve disease in dogs.

OBJECTIVES: To investigate QT instability in dogs with myxomatous mitral valve disease (MMVD) and to determine if this is associated with arrhythmogenesis. ANIMALS: One hundred sixty-seven MMVD dogs that met the study criteria were included. METHODS: Echocardiographic and electrocardiographic data were gathered. Fifty consecutive QT intervals were recorded for each dog. Both heart rate-corrected and uncorrected QT intervals were used to calculate average QT (QTa), QT variance (QTv), total instability (TI), short-term instability (STI), and long-term instability (LTI). Sensitivity and specificity of QTa, QTv, TI, STI, and LTI in identifying arrhythmias and cardiac remodeling were calculated. Patient follow-ups were obtained for analyses of disease progression and survival. RESULTS: An increase related to progression was documented for all the studied indices. QTa and STI best identified dilated hearts and arrhythmias, respectively. Dogs with QTa >272 ms and STI >8 ms were 15% more likely to develop ventricular arrhythmias (likelihood ratios of 2.31 [P = 0.0008] and 2.09 [P = 0.0049], respectively). A QTa >258 ms discriminated American College of Veterinary Internal Medicine stage B1 from stages B2/C disease with a sensitivity of 63% and specificity of 61%. Dogs in American College of Veterinary Internal Medicine stage C of MMVD have higher STI and 3.34 times increased risk of developing arrhythmias when values more than 8 ms are reached. All indices except LTI and QTv showed prognostic value, with increases relating to all-cause mortality. CONCLUSION: Analyses of QT intervals demonstrated changes in STI, LTI, and TI. Increased QT prolongation and instability are significantly related to mortality and may be useful in determining prognosis of MMVD patients.

Differential Recruitment of Dendritic Cells Subsets to Lymph Nodes Correlates with a Protective or Permissive T-Cell Response during Leishmania (Viannia) Braziliensis or Leishmania (Leishmania) Amazonensis Infection.

Leishmania (L.) amazonensis (La) and L. (V.) braziliensis (Lb) are responsible for a large clinical and immunopathological spectrum in human disease; while La may be responsible for anergic disease, Lb infection leads to cellular hypersensitivity. To better understand the dichotomy in the immune response caused by these Leishmania species, we evaluated subsets of dendritic cells (DCs) and T lymphocyte in draining lymph nodes during the course of La and Lb infection in BALB/c mice. Our results demonstrated a high involvement of DCs in La infection, which was characterized by the greater accumulation of Langerhans cells (LCs); conversely, Lb infection led to an increase in dermal DCs (dDCs) throughout the infection. Considering the T lymphocyte response, an increase of effector, activated, and memory CD4(+) T-cells was observed in Lb infection. Interleukin- (IL-) 4- and IL-10-producing CD4(+)and CD8(+) T-cells were present in both La and Lb infection; however, interferon- (IFN-) γ-producing CD4(+)and CD8(+) T-cells were detected only in Lb infection. The results suggest that during Lb infection, the dDCs were the predominant subset of DCs that in turn was associated with the development of Th1 immune response; in contrast La infection was associated with a preferential accumulation of LCs and total blockage of the development of Th1 immune response.

Cardiotoxicity of Senna occidentalis in sheep (Ovis aries).

The cardiotoxicity of Coffee senna (Senna occidentalis) was investigated in sheep that were fed diets containing its seeds, which are recognized as the most poisonous part of such weed. Dianthrone, the main toxic component of S. occidentalis, is known to impair mitochondrial oxidative phosphorylation, leading to myofiber degeneration. In this study, fifteen ewes were fed 0%, 2% or 4% of seeds of S. occidentalis for 63 days. Non-specific markers of myocyte injury and electrocardiograms were undertaken at baseline, and at 14, 35, and 63 days after the animals were first fed the diets, while histopathology of heart samples was performed at the very end of the study. Our results showed an increase in serum AST and LDH over time, while CK-MB did not change significantly. Changes that could be ascribed to myocardial damage were not documented in the electrocardiograms. Cardiac histopathology demonstrated only mild-to-moderate vacuolar degeneration, myofiber edema and disarray, structural disorganization, and cellular necrosis. In conclusion, S. occidentalis caused myocardial fiber degeneration in a dose-dependent fashion, but the electrocardiogram was not able to identify these lesions non-invasively. Because the markers of myofiber injury used in this study lack specificity, they may not be used to support cardiac impairment objectively, despite some of them did change over time.

Risk factors of pancreatic graft loss and death of receptor after simultaneous pancreas/kidney transplantation.

Simultaneous pancreas/kidney transplants require a long graft survival and the recipient to present with more benefits than risks. We evaluated the risk factors of receptor's death and pancreatic graft loss on 2 occasions (3 and 12 months' postoperatively) in 292 transplants in whom 22 variables were evaluated. Variables were selected, 9 receivers, 8 donors, and 5 variables related to the surgical procedure. All independent variables were compared with the dependent variables of pancreatic graft losses and patient deaths. Those considered significant according to univariate analysis were analyzed by using multiple logistic regression techniques in an attempt to develop a mathematical model capable of predicting both pancreatic graft and patient losses. Lastly, based on the resulting models with all significant variables, scores were created to determine the risk of patient death and pancreatic graft loss. In the adjusted multivariate analysis, the significant variables were donor age, receiver's body mass index, initial pancreas implant, iliac venous drainage, and use of induction therapy related to pancreatic loss within 3 months after transplantation. Independent risk factors regarding the loss of patients within 12 months were body mass index and receptor induction therapy. The variables related to pancreatic graft loss within 3 months were donor age, receiver body mass index, initial use of pancreatic graft, iliac venous drainage, and induction therapy; these variables can be used for creating a risk score. The donor body mass index and the induction therapy were independently related to patient loss within 12 months after the transplant.

Detecção de formas amastigotas em exame parasitológico de esfregaço obtido a partir de suabe conjuntival de cães com leishmaniose visceral / Detection of amastigote forms in a parasitological exam of smears made from conjuntival swab in dogs with visceral leishmaniasis

Leishmaniose é uma enfermidade multissistêmica cujas manifestações clínicas são extremamente variáveis. Em cães sinais clínicos oftálmicos são relativamente frequentes, ainda que outros sinais sistêmicos não sejam identificados. Atualmente, o diagnóstico da doença baseia-se em métodos parasitológicos, sorológicos e moleculares, mas, até o momento, a identificação de formas amastigotas desse parasito em esfregaços feitos a partir de suabes conjuntivais não é empregada rotineiramente. Valendo-se de cães sorologicamente positivos para leishmaniose, portadores (G1) ou não (G2) de alterações oftálmicas, este estudo avaliou a viabilidade do esfregaço a partir de suabe conjuntival como método de diagnóstico para a enfermidade. O exame suprarreferido foi positivo em 60% dos animais do G1 e 38,1% do G2, no entanto não houve diferença estatisticamente significativa em relação à positividade nos dois grupos (P=0,2167). Os dados apontam para uma tendência de os cães com leishmaniose e com sinais oftálmicos serem positivos ao exame parasitológico de esfregaço a partir de suabe conjuntival, podendo esse método ser útil no diagnóstico parasitológico da leishmaniose canina.

Leishmaniasisis is a multisystemic disease with varying clinical presentations. In dogs, alterations in the eyes are commonly observed even in animals with no systemic signs. The diagnosis of leishmaniasis is currently based on parasitological, serological and molecular methods, although the identification of amastigote forms of this parasite in conjunctival swabs is not a routine technique in clinical practice. Serologically positive dogs for leishmaniasis presenting (G1) or not (G2) ocular alterations were enrolled in this study to evaluate the conjunctival swab as a method for the diagnosis of this disease. The parasitological evaluation of the swabs disclosed 60% positivity for dogs in group 1, whereas only 38.1% of dogs in group 2 were positive. However, no significant difference was documented between the two groups (P=0.2167). Our data suggest a tendency for dogs with ocular signs to be tested positive in the conjunctival swab exam, thus, this method is useful in the diagnosis of canine leishmaniasis.

Eletrocardiografia computadorizada em cães da raça Beagle / Computerised electrocardiograph in Beagle dogs

Estudaram-se os parâmetros eletrocardiográficos utilizando-se os métodos convencional, computadorizado e computadorizado impresso de 30 cães da raça Beagle clinicamente normais. As medidas eletrocardiográficas dos três diferentes traçados foram analisadas na derivação DII. A comparação entre os métodos revelou diferença nos valores da onda P, onda R, complexo QRS, intervalo QT e intervalo PR e na polaridade da onda T. Este fato deve ser levado em consideração, na dependência do método a ser utilizado.

Electrocardiographic parameters were studied in thirty healthy adult Beagles, using conventional and computerized methods and reading the computerized registration printed on paper. The electrocardiographic measurements of the three different tracings were analyzed in lead II. The results obtained showed that there are differences among the three methods for P wave, R wave, QRS complex, QT interval, PR interval and polarity of the T wave. Special attention should be given to these differences, depending on the chosen method.

Multivariate analysis of risk factors for early loss of pancreas grafts among simultaneous pancreas-kidney transplants.

UNLABELLED: To evaluate the risk factors for pancreas graft loss within 3 months postoperatively among 170 simultaneous pancreas-kidney transplantation (SPKT) we examined 38 variables. METHODS: Twenty-two variables were related to recipients; 12 to donors and 4 to the surgical procedure. In addition the latest follow-up dates as well as the transplant and/or death dates. Independent variables were examined with reference to the dependent pancreatic loss variable, excluding losses owing to deaths. Variables with statistical significance were analyzed to predict early graft loss. RESULTS: Univariate analyses determined the following significant variables: kidney cold ischemia time, older donors, non-white donors, death cause related to vascular disease, wound infection, and length of extended hospitalization. However, multivariate analysis showed that only donor age and kidney cold ischemia time were significant predictors for early pancreatic graft loss. CONCLUSION: Donor age and kidney cold ischemia time were independently related to pancreatic loss after SPKT within 3 months posttransplantation.

Efeitos de diferentes FiO2 sobre variáveis ecocardiográficas em cães submetidos à infusão contínua de propofol / Effects of several FiO2 on the echocardiographic parameters in dogs undergoing continuous infusion of propofol

Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) em cães anestesiados com infusão contínua de propofol e mantidos em ventilação espontânea sobre os parâmetros ecocardiográficos, obtidos em modo M. Oito cães adultos foram submetidos a cinco protocolos anestésicos diferenciando um do outro pela FiO2 fornecida ao paciente. Formaram-se cinco grupos denominados G100 (FiO2=1), G80 (FiO2=0,8), G60 (FiO2=0,6), G40 (FiO2=0,4) e G20 (FiO2=0,21). Os animais foram induzidos à anestesia com propofol na dose necessária para intubação e, ato contínuo, iniciou-se a infusão do fármaco. Os cães receberam oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações foram efetuadas antes da administração do fármaco (M0), aos 30 minutos (M30) após o início da infusão do anestésico e a cada 15 minutos (M45, M60, M75 e M90) durante 60 minutos. Para espessura do septo interventricular ao final da sístole (ESIVs) registrada em M60, a média de G100 foi maior do que as obtidas de G60 e G20. Em M30, o espessamento fracional da parede livre do ventrículo esquerdo (ELPVE) de G100 foi menor que de G80, e, em M75, G80 foi maior que G40. Em relação ao índice de volume ventricular esquerdo ao final da sístole (IVVEFs), em M45, G40 foi maior que G80. Conclui-se que as variáveis ecocardiográficas estudadas não são afetadas pelo emprego de diferentes FiO2.

The effects of several inspired oxygen fractions (FiO2) on the echocardiographic parameters by M-mode were evaluated in eight adult spontaneously breathing mongrel dogs anesthetized with continuous infusion of propofol. Each animal underwent five anesthesia procedures. In each procedure, the patient was allowed to breath a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of propofol. The initial measurement (M0) was performed before any drug administration, the second was recorded 30 minutes after the infusion of propofol (M30), and additional recordings were performed at 15-minute intervals (M45, M60, M75, and M90), during 60 minutes. At M60, for the end-systolic interventricular septum thickness (IVSs), the mean of G100 was greater than G60 and G20. Regarding left ventricular wall fractional thickness (LVWF) at M30, G100 was lower than G80; and at M75, G80 was greater than G40. In relation to left ventricular end-systolic volume index (ESVI), at M45, G40 was greater than G80. In conclusion, different FiO2 does not impair echocardiographic parameters.

Efeitos de diferentes frações inspiradas de oxigênio no índice biespectral em cães submetidos à infusão contínua de propofol / Effects of several inspired oxygen fractions on the bispectral index in dogs submitted to continuous infusion of propofol

Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) sobre o índice biespectral (BIS) em cães submetidos a infusão contínua de propofol e mantidos em ventilação espontânea. Oito cães foram submetidos a cinco anestesias, diferenciando-se uma da outra pela FiO2 fornecida. Formaram-se cinco grupos denominados G100 (FiO2 = 1); G80 (FiO2 = 0,8); G60 (FiO2 = 0,6); G40 (FiO2 = 0,4) e G20 (FiO2 = 0,21). Os animais foram induzidos à anestesia com propofol na dose necessária para intubação, e, ato contínuo, iniciaram-se a infusão do fármaco e o fornecimento de oxigênio, conforme a FiO2 determinada para cada grupo. As primeiras mensurações (M0) foram efetuadas 30 minutos após o início da infusão do anestésico e, depois, em intervalos de 15 minutos (M15, M30, M45 e M60). A pressão parcial de oxigênio no sangue arterial (PaO2) variou conforme a FiO2, ou seja, quanto maior a FiO2, maior foi a PaO2. Para a pressão parcial de dióxido de carbono no sangue arterial (PaCO2), foram registradas diferenças em M30, no qual G100 foi maior que G20. Não foram observadas diferenças significativas nas variáveis estudadas do BIS. Os intervalos de médias registrados para o BIS foram, para G100, de 68 a 62; G80, de 71 a 58; G60, de 72 a 62; G40, de 76 a 68; e G20, de 77 a 68. Conclui-se que as variáveis relacionadas ao BIS não são afetadas pelo emprego de diferentes FiO2, e sugere-se que o monitoramento pelo BIS foi capaz de detectar alterações no equilíbrio do fluxo sangüíneo cerebral, oriundas das alterações ocasionadas na dinâmica respiratória pelo emprego de diferentes frações inspiradas de oxigênio.

The effects of several inspired oxygen fractions (FiO2) on the bispectral index in spontaneously breathing dogs submitted to continuous infusion of propofol were evaluated. Eight adult mongrel dogs were used. Each animal was submitted to five anesthesias. In each procedure, the patient was allowed to breathe a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of drug. The initial measurement (M0) was recorded 30 minutes after the infusion of propofol onset. Additional recordings were performed at 15-minute intervals during 60 minutes (M15, M30, M45, and M60). No significant differences on BIS parameters were recorded. Regarding arterial partial pressure of carbon dioxide (PaCO2), the mean of G100 was greater than G20 at M30, whereas arterial partial pressure of oxygen (PaO2) varied according to the changes in oxygen. The mean intervals of BIS were: for G100, from 68 to 62; for G80, from 71 to 58; for G60, from 72 to 62; for G40 from 76 to 68; and for G20, from 77 to 68. In conclusion, different FiO2 does not impair BIS parameters. However, it is suggested that BIS was able to detect changes in the balance of cerebral blood flow, which was a result of changes in respiratory dynamic by the use of several inspired fractions.

Morphometric and quantitative characterization of atrial ganglion neurons from the intercaval region in dogs with dilated cardiomyopathy / Caracterização morfométrica e quantitativa dos neurônios ganglionares atriais da faixa intercaval de cães com cardiomiopatia dilatada

The quantity, morphometry, and quality of atrial neurons from the intercaval region in dogs with dilated cardiomyopathy (DCM) were evaluated. Dogs with DCM had greater ganglion neurons than control dogs. The histologic evaluation of the ventricular myocardium and ganglion neurons confirmed DCM and showed the degeneration of ganglion neurons. Dogs with chronic DCM had a secondary cardioneuropathy owing to impaired parasympathetic neural control

Avaliaram-se quantitativa, morfométrica e qualitativamente os neurônios atriais da faixa intercaval de cães com cardiomiopatia dilatada (CMD). Os neurônios dos gânglios nervosos de cães com CMD eram maiores que os dos cães controle. A histopatologia do miocárdio ventricular e dos neurônios ganglionares confirmou a CMD e demonstrou evidente processo degenerativo neuronal ganglionar. Cães com CMD em fase crônica apresentavam cardioneuropatia secundária, provavelmente pela privação da inervação parassimpática cardíaca

Variabilidade da freqüência cardíaca em cães anestesiados com infusão contínua de propofol e sufentanil / Heart rate variability in dogs anesthetized with propofol and sufentanil

Foram avaliados os efeitos do propofol associado ao sufentanil sobre o balanço das atividades simpática e parassimpática do coração, investigando-se um possível efeito dose dependente do opióide. Analisou-se a variabilidade da freqüência cardíaca (VFC) de 12 cães adultos pré-medicados com maleato de acepromazina e anestesiados com propofol e três doses diferentes de sufentanil, que variou de 0,025 a 0,1µg/kg/min. Registrou-se o eletrocardiograma 15 minutos após a medicação pré-anestésica e 15, 30, 60, 90 e 120 minutos após a indução anestésica. A VFC foi calculada no domínio da freqüência, mediante análise de 10 intervalos RR consecutivos. Houve redução acentuada da freqüência cardíaca, mas a VFC permaneceu relativamente inalterada.

The effects of propofol and sufentanil on cardiac sympathetic and parasympathetic balance were studied, in order to evaluate if sufentanil plays a role in this balance. The heart rate variability of 12 adult dogs was assessed, after premedication with acepromazine and anesthetized with propofol and three different doses of sufentanil, ranging from 0.025 to 0.1µg/kg/min. Electrocardiograms were recorded 15 minutes after premedication and 15, 30, 60, 90, and 120 minutes after anesthetic induction. Heart rate variability was calculated in frequency domain through the analysis of 10 consecutive RR intervals. Results showed an absence of important changes in heart rate variability, although a significant decrease in heart rate was observed.

Holter electrocardiography in dogs showing doxorubicin-induced dilated cardiomyopathy

Early identification of arrhythmias in dogs showing doxorubicin-induced cardiomyopathy was studied. Ten healthy dogs were assigned to groups A (n=5) and B (n=5). Dogs from group B were given doxorubicin 30mg/m² intravenously, every 21 days, until a cumulative dose of 180mg/m² or 240mg/m² was reached. Dogs from group A (used as control) were administered saline intravenously at the same group B intervals. As soon as myocardium dysfunction was observed in dogs from group B, determined by a shortening fraction below 20 percent, increased E-point to septal separation above 0.7cm, and increased end-systolic left ventricular volume index (61.4ml/m²), a 24-hour Holter was recorded in all dogs from both groups. There was an increase of minimum heart rate (44.6 percent) and mean heart rate (41.7 percent) in animals from group B in comparison with the control animals. Either supraventricular or ventricular arrhythmias were observed, despite group B dogs showed higher occurrence of supraventricular arrhytmias. Holter monitoring is efficient in early determination of heart rate and cardiac rhythm alterations in dogs showing doxorubicin-induced myocardial dysfunction.

O estudo consistiu na identificação precoce da ocorrência de arritmias em cães com cardiomiopatia dilatada experimental induzida pela doxorrubicina (DOX). Utilizaram-se 10 cães adultos, sadios, distribuídos nos grupos A (n=5) e B (n=5). O grupo B recebeu 30mg/m² de DOX, via intravenosa, a cada 21 dias, até a dose cumulativa de 180 ou 240mg/m². No grupo A (controle), administrou-se solução salina 0,9 por cento, via intravenosa, nos mesmos intervalos do grupo B. Ao se evidenciar o quadro de disfunção miocárdica nos cães do grupo B, caracterizado pela fração de encurtamento menor que 20 por cento, aumento da separação septal do ponto E acima de 0,7cm e aumento do índice volumétrico do ventrículo esquerdo ao final da sístole (61,4ml/m²), realizaram-se os eletrocardiogramas por 24 horas. Os resultados demonstraram aumentos de 44,6 por cento e 41,7 por cento nas freqüências cardíacas mínima e média, respectivamente, e presença, com maior freqüência, de arritmias supraventriculares do que ventriculares nos animais do grupo B. Concluiu-se que o Holter é eficaz e demonstra, com precocidade e melhor definição, as alterações da freqüência e do ritmo cardíaco de cães com disfunção miocárdica induzida pela doxorrubicina.