RESUMO
OBJECTIVES: The goal of this article is to examine the correlation of catheter (cath) based and echocardiographic assessment of aortic stenosis (AS) in a community-based academic hospital setting, particularly in the degree that decision to refer for surgery is altered. BACKGROUND: Current guidelines discourage AS evaluation by invasive pressure measurement if echocardiography (echo) is adequate, but several studies show sizable differences between echo and cardiac catheterization lab (CCL) measurements. We examine this correlation using high quality CCL techniques. METHODS: Sequential patients with suspected AS by echo (n = 40) aged 61-94 underwent catheterization with pressure gradients via left ventricular pressure wire and ascending aorta catheter. The echos leading to the catheterization were independently reviewed by an expert panel to assess the quality of community-based readings. RESULTS: CCL changed assessment of severity of aortic valve area (AVA) by more than 0.3 cm(2) in 25% and 0.5 cm(2) in 8%. Values changed to over or under the surgical threshold of AVA < 1 cm(2) in 30% of the patients. Pearson correlation of 0.35 between measurements of AVA by echo and CCL is lower than earlier studies, which often reported correlation values of 0.90 or greater. Echo expert reviews provided minimal improvement in discrepancies (Pearson correlation of 0.46), suggesting quality of initial interpretation was not the issue. CONCLUSIONS: Cath-echo correlation of AS severity is lower in contemporaneous practice than previously assumed. This can alter the decision for aortic valve replacement. Sole reliance on echo-derived assessment of AS may at times be problematic.
Assuntos
Estenose da Valva Aórtica/diagnóstico , Cateterismo Cardíaco , Ecocardiografia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Função Ventricular Esquerda , Pressão VentricularRESUMO
The subgenus Persexarthrus Voss, 1944 of the weevil genus Anthonomus Germar, 1817 is revised. Anthonomus (Persexarthrus) behnei sp. n. is described. A neotype of Bradybatus ornatoides Reitter, 1898 and lectotypes for Anthonomus baudueri var. abeillei Desbrochers des Loges, 1892, A. cyprius Marshall, 1925 and Neobradybatus variabilis Hoffmann, 1963 are designated. The five species of the subgenus are described, keyed and their distributions given.
Assuntos
Besouros/anatomia & histologia , Besouros/classificação , Animais , Feminino , Masculino , Especificidade da EspécieRESUMO
The genus Cleopus Dejean, 1821 is herein revised for the first time. Based on adult morphological characteristics, 18 species are recognized as valid. Thirteen species, all distributed in the Eastern Palaearctis or Oriental region, are described as new: C. aduncirostris sp. n.; C. cognatus sp. n.; C. confusus sp. n.; C. dohertyi sp. n.; C. hajeki sp. n.; C. lirenae sp. n.; C. longitarsis sp. n.; C. minutus sp. n.; C. pallidisquamosus sp. n.; C. parvidentatus sp. n.; C. philippinensis sp. n.; C. simillimus sp. n.; and C. subaequalis sp. n. Lectotypes of following two valid species and three synonyms were designated: Curculio solani Fabricius, 1792; Curculio pulchellus Herbst, 1795; Cionus setiger Germar, 1821; Curculio immunis Marsham, 1802; and Cleopus pulchellus rigidus Stephens, 1831. Neotypes of Curculio perpensus Rossi, 1792 and Cleopus pulchellus flavus Stephens, 1832 were designated. The following new synonyms of Cleopus pulchellus (Herbst, 1795) were established: Cleopus pulchellus var. flavus Stephens, 1831 syn. n. and C. pulchellus var. rigidus Stephens, 1831 syn. n.
RESUMO
The Afrotropical species of the genus Cionus Clairville, 1798 are revised and 52 species are recognized as valid. Thirty-one species are described as new to the science: twenty-five from the continental subregions (C. concavifrons sp. n., C. coniungens sp. n., C. cretaceus sp. n., C. diaboli sp. n., C. fimbriatus sp. n., C. frater sp. n., C. friedmani sp. n., C. geometricus sp. n., C. hirtellus sp. n., C. intermedius sp. n., C. latruncularius sp. n., C. limosus sp. n., C. longinasus sp. n., C. mimeticus sp. n., C. natalensis sp. n., C. nhlosanicus sp. n., C. oberprieleri sp. n., C. oculatus sp. n., C. schuelei sp. n., C. stalsi sp. n., C. tanzanicus sp. n., C. tenuepilosus sp. n., C. terrosus sp. n., C. transvaalicus sp. n., C. zimbabwicus sp. n.) and six from Madagascar (C. callosus sp. n., C. convexiusculus sp. n., C. guttula sp. n., C. planus sp. n., C. variolosus sp. n., C. verrucosus sp. n.). The following new synonymies are proposed: Cionus chilianthi Marshall, 1941 syn. n. of C. angulicollis Rosenschoeld, 1838, C. virgatus Rosenschoeld, 1838 syn. n. and C. decorus Boheman, 1845 syn. n. of C. nubilosus Rosenschoeld, 1838, C. leucostictus griseus Fairmaire 1903 syn. n. of C. leucostictus Fairmaire, 1897. Lectotypes of Cionus albidus Rosenschoeld, 1838, C. alluaudi Hustache, 1920, C. angulicollis Rosenschoeld, 1838, C. catenatus Fairmaire, 1897, C. compactus Fairmaire, 1903, C. coriaceus Fairmaire, 1903, C. decorus Boheman, 1845, C. ebeninus Hustache, 1956, C. histrio Rosenschoeld, 1838, C. ingratus Fåhraeus, 1871, C. leucostictus Fairmaire, 1897, C. leucostictus griseus Fairmaire, 1903, C. notatus Rosenschoeld, 1838, C. nubilosus Rosenschoeld, 1838, C. perlatus Faust, 1885, C. pustulatus Fåhraeus, 1871, C. tristis Boheman, 1838, C. usambicus Faust, 1889, C. vicarius Hustache, 1939 and C. virgatus Rosenschoeld, 1838 are designated. The "variety" maculithorax Voss, 1960 of Cionus pardus Marshall, 1941 is considered an unavailable name. Description or redescription, comparative morphology, distribution, biological notes and key to all Afrotropical species are given. Photos of habitus in dorsal, of aedeagus in ventral and lateral, and of the apex of penis in dorsal view are reported for each species.
RESUMO
Oriental species of the genus Cionus are herein revised for the first time. Eight species are recognized as distinct based on morphological characters of adults. One species is described as new: C. ottomerkli sp. nov., from India, whereas the name vossi (nom. nov.) is proposed for Cionus flavoguttatus Voss, 1957 (not Stierlin, 1893). The following new synonymy is established: Cionus indicus Desbrochers des Loges, 1890 (=Cionus albosparsus Faust, 1898 syn. nov.). Lectotypes of Cionus albosparsus Faust, 1898; Cionus flavoguttatus Voss, 1957; Cionus indicus Desbrochers des Loges, 1890; Cionus obesus Pascoe, 1883; and Cionus tonkinensis Wingelmüller, 1915, are designated.
RESUMO
Palaearctic species of the genus Cionus Clairville, 1798 are revised and 61 species are recognized as valid. Sixteen species are described as new to science: Cionus armeniacus sp. n., C. boroveci sp. n., C. colonnellii sp. n., C. dodeki sp. n., C. harani sp. n., C. himalayensis sp. n., C. khorasanicus sp. n., C. laibalei sp. n., C. maurus sp. n., C. negevicola sp. n., C. neglectus sp. n., C. osmanlis sp. n., C. rossicus sp. n., C. rufescens sp. n., C. winkelmanni sp. n. and C. yunnanensis sp. n. Cionus auriculus Reitter, 1904 stat. n. is resurrected from the synonymy of C. hortulanus (Geoffroy, 1785), C. atlanticus Peyerimhoff, 1926 stat. prom. is raised to specific rank from C. longicollis atlanticus, C. montanus Wingelmüller, 1914 stat. prom. is raised to specific rank from C. longicollis montanus, C. affinis Brahm, 1790 syn. n. is synonymized with C. scrophulariae (Linnaeus, 1758), C. franzi A. Hoffmann, 1960 syn. n. with C. hortulanus (Geoffroy, 1785), C. inexspectatus Tempère, 1961 syn. n. with C. leonhardi Wingelmüller, 1914, C. pulverosus densenotatus Reitter, 1914 syn. n. with C. pulverosus Guérin-Méneville, 1833, C. schoenherri laportei A. Hoffmann, 1953 syn. n. with C. schoenherri C. N. F. Brisout de Barneville, 1863, C. schultzei nuristanus Voss, 1937 syn. n. with C. dependens Faust, 1886, C. scrophulariae albosuturatus Roubal, 1936 syn. n. with C. scrophulariae (Linnaeus, 1758), C. subsquamosus Reitter, 1914 syn. n. with C. hortulanus (Geoffroy, 1785), C. thapsus semialbellus Reitter, 1904 syn. n. with C. gebleri Gyllenhal, 1838, C. thapsus tissoni Reitter, 1904 syn. n. with C. thapsus (Fabricius, 1792). Neotypes of Cionus griseopubens Wingelmüller, 1914, Cionus ungulatus Germar, 1821, Cionus villae Comolli, 1837, Curculio affinis Brahm, 1790, Curculio alauda Herbst, 1784, Curculio bipustulatus Marsham, 1802 and Curculio tuberculosus Scopoli, 1763 are designated. Curculio thapsus Fabricius, 1792 (currently Cionus) is formally proposed as nom. protectum and Curculio assimilis Harrer, 1784 as nom. oblitum. Redescriptions, comparative morphology, distributions, biological notes and key to all Palaearctic species are given.
Assuntos
Besouros , Ortópteros , Gorgulhos , AnimaisRESUMO
The larva and the pupa of the Palaearctic weevil species Tychius subsulcatus Tournier, 1847 are described and illustrated for the first time. The characters of larva and pupa of T. subsulcatus completely fit the described differential diagnosis of the subtribe Tychiina, genus Tychius, and also Tychius intrusus group. Astragalus onobrychis Linnaeus is confirmed as its host plant. The biology of T. subsulcatus in south Slovakia (Cerová vrchovina Mts.) is described.
Assuntos
Besouros , Gorgulhos , Animais , Larva , Filogenia , Pupa , EslováquiaRESUMO
BACKGROUND: Levosimendan is a calcium-sensitizing agent and an inodilator under current investigation in the treatment of decompensated heart failure. The effects of intravenous levosimendan on the human coronary vasculature, together with myocardial wall stress and oxygen uptake, have not been adequately studied. METHODS AND RESULTS: Ten adult patients underwent right- and left-heart catheterization. Baseline coronary blood flow was determined with quantitative coronary angiography and an intracoronary Doppler-tipped guidewire. Myocardial oxygen uptake was measured with a coronary sinus catheter. Echocardiography was performed before and 30 minutes after an intravenous infusion of levosimendan (24-microg/kg bolus over 10 minutes) was begun. Pulmonary capillary wedge decreased 37% (P=0.009), cardiac output increased 9% (P=0.04), and systemic vascular resistance decreased 18% (P<0.001). Left ventricular ejection fraction increased 20% (P=0.009), and meridional systolic wall stress decreased 48% (P=0.009). Coronary artery diameter increased 10% at 15 minutes (P=0.001) and 11% at 30 minutes (P=0.01). Coronary artery velocity increased 10% over baseline (P=0.04). Coronary blood flow increased 45% (P=0.02), whereas coronary resistance decreased 36% at 30 minutes (P=0.03). Myocardial oxygen extraction decreased 9% at 30 minutes (P=0.04). CONCLUSIONS: Levosimendan given intravenously exerts vasodilator effects on human coronary conductance and resistance arteries. Despite a decrease in coronary perfusion pressure, coronary blood flow is increased. A reduction in coronary vascular resistance and a decrease in coronary venous oxygen content indicate primary coronary vasodilation by levosimendan. Improved left ventricular systolic function and decreased myocardial oxygen extraction suggest improved myocardial efficiency.
Assuntos
Hidrazonas/administração & dosagem , Miocárdio/metabolismo , Consumo de Oxigênio/efeitos dos fármacos , Piridazinas/administração & dosagem , Sistema Vasomotor/efeitos dos fármacos , Disfunção Ventricular Esquerda/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/efeitos dos fármacos , Simendana , Resistência Vascular , Vasodilatação/efeitos dos fármacosRESUMO
The male of the recently described Acentrus boroveci Kostál, 2014 is described for the first time, and characters to differentiate it from males of the two other species of Acentrus Desmarest, 1839 are given.
Assuntos
Gorgulhos/classificação , Distribuição Animal , Estruturas Animais/anatomia & histologia , Estruturas Animais/crescimento & desenvolvimento , Animais , Tamanho Corporal , Feminino , Masculino , Tamanho do Órgão , Gorgulhos/anatomia & histologia , Gorgulhos/crescimento & desenvolvimentoRESUMO
The larvae and pupae of six species of the Palaearctic genus Sibinia Germar, 1817 are described in detail for the first time. Five of them develop in seeds of Caryophyllaceae and belong to Sibinia (s. str.): S. attalica Gyllenhal, 1835; S. femoralis Germar, 1824; S. tibialis Gyllenhal, 1835; and S. viscariae (Linnaeus, 1760), which are included in the S. femoralis group, and S. sicana Ragusa, 1908, which is included in the S. unicolor Fåhraeus, 1843 group. The sixth species is S. sodalis Germar, 1824, which develops in seeds of Plumbaginaceae and belongs to the subgenus Dichotychius Bedel, 1885. The larvae and pupae of these species are compared with those previously described for some species of the third subgenus, Microtychius Casey, 1910 from the Americas. Some larval characters, but no pupal ones, are useful to support the three subgenera and the two previously mentioned groups of Sibinia s. str., which were previously postulated based on a few adult morphological characters. The immatures of Sibinia are also compared with those of the closely related genus Tychius Germar, 1817, providing some distinctive characters between both genera. New bionomic data on larval and pupal development and adult emergence are reported for all the described species. These data suggest that species in this genus are highly homogeneous in life history traits.