Repositório RCAAP

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OBJECTIVE: To evaluate whether left ventricular end-systolic (ESD) diameters <FONT FACE=Symbol>£</FONT> 51mm in patients (pt) with severe chronic mitral regurgitation (MR) are predictors of a poor prognosis after mitral valve surgery (MVS). METHODS: Eleven pt (aged 36±13 years) were studied in the preoperative period (pre), median of 36 days; in the early postoperative period (post1), median of 9 days; and in the late postoperative period (post2), mean of 38.5±37.6 months. Clinical and echocardiographic data were gathered from each pt with MR and systolic diameter <FONT FACE=Symbol>³</FONT>51mm (mean = 57±4mm) to evaluate the result of MVS. Ten patients were in NYHA Class III/IV. RESULTS: All but 2 pt improved in functional class. Two pt died from heart failure and infectious endocarditis 14 and 11 months, respectively, after valve replacement. According to ejection fraction (EF) in post2, we identified 2 groups: group 1 (n=6), whose EF decreased in post1, but increased in post2 (p=0.01) and group 2 (n=5), whose EF decreased progressively from post1 to post2 (p=0.10). All pt with symptoms lasting <FONT FACE=Symbol>£</FONT> 48 months had improvement in EF in post2 (p=0.01). CONCLUSION: ESD <FONT FACE=Symbol>³</FONT>51mm are not always associated with a poor prognosis after MVS in patients with MR. Symptoms lasting up to 48 months are associated with improvement in left ventricular function.

OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT) in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole) and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina) and "any" (major event or coronary angioplasty or new myocardial revascularization surgery). RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

OBJECTIVE: To assess the usefulness of Doppler tissue imaging (DTI) for evaluating the systolic function of chagasic patients with and without electrocardiographic abnormalities, in comparision with echocardiographic study. METHODS: We studied 77 patients divided into 3 groups as follows: group 1 - control; group 2 - chagasic patients with normal electrocardiographic findings; and group 3 - chagasic patients with abnormal electrocardiographic findings. The following parameters were assessed: left ventricular dimensions and ejection fraction, left atrial dimensions and diastolic function on echocardiography. Systolic velocity and regional isovolumic contraction time (IVCTr) of the septal, anterior, lateral, posterior and inferior left ventricular walls were assessed on DTI. RESULTS: Left ventricular cavitary dimensions, ejection fraction and DTI systolic wave showed significant differences between groups 1 and 3 and between groups 2 and 3, which were not found between groups 1 and 2. IVCTr allowed a statistically significant discrimination among the 3 groups. CONCLUSION: DTI allowed discrimination among the different groups assessed, being superior to echocardiography in identifying early abnormalities of contractility, and, therefore, potentially useful for detecting incipient myocardial alterations in chagasic patients with normal electrocardiographic findings.

OBJECTIVE: To investigate preoperative predictive factors of severe perioperative intercurrent events and in-hospital mortality in coronary artery bypass graft (CABG) surgery and to develop specific models of risk prediction for these events, mainly those that can undergo changes in the preoperative period. METHODS: We prospectively studied 453 patients who had undergone CABG. Factors independently associated with the events of interest were determined with multiple logistic regression and Cox proportional hazards regression model. RESULTS: The mortality rate was 11.3% (51/453), and 21.2% of the patients had 1 or more perioperative intercurrent events. In the final model, the following variables remained associated with the risk of intercurrent events: age <FONT FACE=Symbol>³</FONT> 70 years, female sex, hospitalization via SUS (Sistema Único de Saúde - the Brazilian public health system), cardiogenic shock, ischemia, and dependence on dialysis. Using multiple logistic regression for in-hospital mortality, the following variables participated in the model of risk prediction: age <FONT FACE=Symbol>³</FONT> 70 years, female sex, hospitalization via SUS, diabetes, renal dysfunction, and cardiogenic shock. According to the Cox regression model for death within the 7 days following surgery, the following variables remained associated with mortality: age <FONT FACE=Symbol>³</FONT> 70 years, female sex, cardiogenic shock, and hospitalization via SUS. CONCLUSION: The aspects linked to the structure of the Brazilian health system, such as factors of great impact on the results obtained, indicate that the events investigated also depend on factors that do not relate to the patient's intrinsic condition.

OBJECTIVE: To determine whether recording of the activation potential may be used as an isolated criterion to guide catheter ablation of atriofascicular Mahaim fibers. METHODS: We studied 6 patients (5 females, mean age of 26±7.3 years) with paroxysmal tachycardias with a wide QRS complex, whose electrophysiological study diagnosed atriofascicular Mahaim fibers. Mapping and catheter ablation were performed in sinus rhythm, guided only by the recording of the activation potential of the fiber. RESULTS: Efficacy in ablation was achieved in all patients. The fibers were located in the right lateral region of the tricuspid ring in 3 patients, right posterolateral region in 2, and right anterolateral region in 1. A mean of 5.3±3 radiofrequency applications was performed. The mean fluoroscopy time was 46.6±25 minutes, and the mean duration of the procedure was 178.6±108 minutes. No complication occurred. In a mean 20-month follow-up, all patients were asymptomatic and receiving no antiarrhythmic drugs. CONCLUSION: Catheter ablation of Mahaim fibers may be performed with good safety and efficacy by mapping the activation potential of the tricuspid ring in sinus rhythm.

OBJECTIVE: To assess the in-hospital evolution of patients undergoing percutaneous stent placement in the carotid arteries. METHODS: From August 1996 to April 2001, we studied 86 patients with carotid arterial obliterative lesions > 70% who were treated with percutaneous stent placement in the carotid arteries. We assessed the rate of success of the implantation and of the procedure, the types of stents used, mortality rate, and neurological complications. RESULTS: Successful implantation was obtained in 98.9% of the cases, and the procedure was successful in 91.8%. The Wallstent was the most frequently used stent (73 patients - 77%). Cerebral strokes occurred as follows: 3 (3.2%) transient ischemic attacks, 1 (1.1%) minor stroke, and 3 (3.1%) major strokes. One (1.1%) patient died during hospitalization. CONCLUSION: The high rate of success of stent implantation (98.9%) in addition to the low rate of cerebral stroke/death (4.2%) showed the efficiency and safety of percutaneous stent placement in carotid arteries.

OBJECTIVE: To assess blood pressure measurement by health professionals of a public hospital in São Paulo State. METHODS: Semi-structured interviews and direct observation were performed with a verification list according to the criteria reported by Perloff et al. One hundred and five health professionals took part in the study. After measuring blood pressure, the level of concordance between the way the procedure was performed and the recommended one was assessed. RESULTS: Nurses and nurse's aides abided by 40% of the recommended procedures for adequate blood pressure measurement. The other categories of health professionals (nursing and medicine teachers, physicians, residents, and nursing students) abided by approximately 70%. CONCLUSION: Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.

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A new species, Ruffojassa petronioi sp. nov., is described from southern Brazilian coast. The new species was collected at 56 m depth at the coordinates 21º42'S / 40º15'W with a mini biological trawl aboard of R.V. Prof.W.Besnard. In this paper we recorded the genus for the first time from Brazilian waters.

A new species of the family Melitidae Bousfield, 1973, Melita petronioi sp. nov., is described with material collected from Patos Lagoon, coast of the Brazilian state of Rio Grande do Sul, southern Brazil. The new species is the unique species of Melita Leach, 1814 in Brazilian waters with urosomites 1 and 2 lacking spines, but urosomite 2 bearing two sets of dorsal stout setae, and the uropod 3 with the outer ramus 2-articulate. It is the first Melita species recorded to the southern region of the country.

To date the genus Atlantoscia Ferrara and Taiti, 1981 includes two species, A. floridana (van Name, 1940) and A. rubromarginata Araujo and Leistikow, 1999. The species Atlantoscia petronioi sp.n. is described on the basis of material collected in a coastal dune forest area of the southern Rio Grande do Sul state, Brazil. This new species is characterized by antenna with accentuate setose sulcus from the peduncle to the distal article of the flagellum, outer endite of maxillula with slender seta among the outer group teeth and accessory tooth, one trifid tooth in the inner group, and male pleopod 1 endopod with distal part pointed and subapically not swollen.

The decapod crustaceans inhabiting dead portions of the fire-coral Millepora alcicornis Linnaeus, 1758 and coral rubble were surveyed in six reef areas on the coast of the state of Bahia, Brazil, in 2011. A total of 453 specimens belonging to 39 species in the infraorders Stenopodidea (family Spongicolidae), Caridea (families Palaemonidae, Alpheidae, Hippolytidae, and Processidae), Axiidea (family Callianassidae), Gebiidea (family Upogebiidae), Anomura (family Porcellanidae), and Brachyura (families Majidae, Pilumnidae, Domeciidae, Panopeidae, and Grapsidae) were collected. Members of the families Alpheidae and Porcellanidae were prominent, with 14 and 9 species, respectively. Of the species collected, the alpheid shrimp Alpheus peasei (Armstrong, 1940) is recorded for the first time in the southwestern Atlantic. Microprosthema semilaeve (von Martens, 1872), Corallianassa hartmeyeri Schmitt, 1935, and Petrolisthes marginatu Stimpson, 1859 also had their known geographic ranges extended along the western Atlantic. Alpheus nuttingi (Schmitt, 1924), Synalpheus scaphoceris Coutière, 1910, and Pachycheles riisei (Stimpson, 1858) are new records for Bahia.

The barbouriid shrimp Janicea antiguesis (Chace, 1972) is reported from Porto de Galinhas and Tamandaré in Pernambuco and Guarapari in Espírito Santo, Brazil. These records confirm the presence of J. antiguensis in northeastern and eastern Brazil, considerably extending its Brazilian range from Fernando de Noronha to southern Espírito Santo and also representing the first record of this species from mainland coastal reefs. In Brazil, J. antiguensis occurs in or near marine reef caves, typically at depths between 5 and 15 m, and can be most easily observed while scuba diving at night. Colour photographs of J. antiguensis from various Atlantic localities are provided and its colour pattern is compared to that of the closely related Indo-West Pacific barbouriid shrimp, Parhippolyte misticia (Clark, 1989). Some in situ observations are provided for the Porto de Galinhas population of J. antiguensis. Multiple observations of pairs with both individuals brooding embryos at different developmental stages suggest protandric simultaneous hermaphroditism in J. antiguensis.

The present study provided information extending the known geographical distribution of three species of majoid crabs, the epialtids Acanthonyx dissimulatus Coelho, 1993, Epialtus bituberculatus H. Milne Edwards, 1834, and E. brasiliensis Dana, 1852. Specimens of both genera from different carcinological collections were studied by comparing morphological characters. We provide new data that extends the geographical distributions of E. bituberculatus to the coast of the states of Paraná and Santa Catarina (Brazil), and offer new records from Belize and Costa Rica. Epialtus brasiliensis is recorded for the first time in the state of Rio Grande do Sul (Brazil), and A. dissimulatus is reported from Quintana Roo, Mexico. The distribution of A. dissimulatus, previously known as endemic to Brazil, has a gap between the states of Espírito Santo and Rio de Janeiro. However, this restricted southern distribution is herein amplified by the Mexican specimens.

This study investigated the composition and spatial distribution of the sublittoral decapods on the reefs of Porto de Galinhas Beach, southern coast of Pernambuco, Brazil, through the Underwater Visual Census technique. Data were collected monthly, at night during full-moon tides in low tide periods from June 2004 to May 2005, using SCUBA diving and a visual census with a fixed belt transect (20 m long). Three sampling areas were defined: Confined Waters (low hydrodynamics) with shallow sites (up to 2.5 m deep); Semi-open Water (3 to 6 m deep), influenced by waves and tidal currents (moderate hydrodynamics); and Open Water (7 to 10 m deep), in the breaker zone (high hydrodynamics). A total of 6,287 individuals of 34 species belonging to the infraorders Brachyura (19 species), Achelata and Anomura (5 species each), Caridea (3 species), and Stenopodidea and Astacidea (1 species each) were collected. Two decapod assemblages were distinguished: in a habitat with low hydrodynamics and shallow (Confined) water; and in a habitat with moderate to high hydrodynamics and depths of 3 to 10 m (Semi-open and Open water). At the sites with high hydrodynamics, i.e., the Open-water Area in the breaker zone, decapod diversity was significantly lower than in the other, protected areas on the reef bench. These results suggest that the distribution of subtidal decapods on coastal reefs is influenced by depth and exposure to water stress caused by waves and currents (hydrodynamics). The visual census technique with SCUBA proved to be suitable for ecological studies on subtidal decapods.

The taxonomy of the 11 species of fiddler crabs [Uca (Uca) maracoani (Latreille, 1802-1803), U. (U.) tangeri (Eydoux, 1835), U. (Minuca) burgersi Holthuis, 1967, U. (M.) mordax (Smith, 1870), U. (M.) rapax (Smith, 1870), U. (M.) thayeri Rathbun, 1900, U. (M.) victoriana von Hagen, 1987, U. (M.) vocator (Herbst, 1804), U. (Leptuca) cumulanta Crane, 1943, U. (L.) leptodactyla Rathbun, 1898 and U. (L.) uruguayensis Nobili, 1901] of the South Atlantic Ocean is reviewed. Keys for identification, updating the keys for the Atlantic Ocean are proposed, including the species recently described. Comments reporting morphological variations among types and additional material and among populations of different localities are included. The Atlantic species are divided into three subgenera: Uca s. str., Minuca and Leptuca. The eastern Atlantic species U. (U.)tangeri is included in subgenus Uca s. str. due to the presence of a proximal spine opposing the spoon-tipped setae of the second maxilliped, which is considered an apomorphic character of the subgenus Uca s. str.

The purpose of the present study was to investigate the biodiversity, relative abundance and frequency of decapod crustaceans in the marine mangrove ecosystem at Gaibu Beach, Pernambuco State, Brazil. A total of eight samples were taken: four in the rainy season (August 2010) and four in the dry season (February 2011), during spring low tides and according to the phases of the moon. In all, 352 decapods were sampled. These specimens belonged to 17 species, 14 genera and 13 families. Pachygrapsus transversus (Gibbes, 1850), P. gracilis (Saussure, 1858), Panopeus americanus Saussure, 1857 and Uca (Leptuca) leptodactyla Rathbun, 1898 were very frequent. The three latter species occurred in all samples. The most abundant species was P. americanus. The Shannon-Wiener index (H') showed that, in general, the diversity level was medium for all samples. However, the sample taken at the time of the new moon during the rainy season was classified as highly diverse. These results contribute to the knowledge of the decapod fauna inhabiting mangroves associated with fringe reefs.