Prognosis of postoperative aortic dissection. Assessment with magnetic resonance]

OBJECTIVE: To evaluate operated type A aortic dissection by Magnetic Resonance Imaging (MRI), in order to detect long-term complications and identify prognostic indexes of evolution. DESIGN: Prospective study with a three-year period of follow-up. Prognosis evaluation. SETTINGS: Outpatient Clinic at Hospital de Santa Maria and Magnetic Resonance Imaging Center at Hospital da Cruz Vermelha. PATIENTS: A sample of 37 patients submitted to type A aortic dissection surgery, included sequentially, after exclusion of those with contraindication to MRI. METHODS: Initial evaluation (clinical and MRI study) at 3 to 4 months and at 1, 2 and 3 years after surgery. The mean follow-up time was 39.3 +/- 2.9 months. We evaluated the following complications over the aorta (aortic graft and five segments of residual aorta) and the aortic valve: aneurysm, pseudoaneurysm, rupture, re-dissection, progressive aortic valve regurgitation, reoperation and death. The prognostic indexes analysed were: presence of residual flap; false lumen patency; presence of re-entry points; false lumen to aorta dimension ratio; initial aortic dimension; increase of aortic dimension. RESULTS: All patients, with the exception of three that died, remained asymptomatic. COMPLICATIONS: Aneurysm was detected in 45.9% of patients, located in one or more segments; rupture occurred in three patients, preceded by aneurysm and pseudoaneurysm development; moderate or severe aortic regurgitation was detected in 47.8% of patients. Prognostic indexes: 1. Aneurysm development in each segment yeilded a significant association with: presence of residual flap in the same and other segments; higher initial dimension of the same and other segments, with the exception of the abdominal segment; higher increase in dimension of the same and other segments, with the exception of the abdominal segment; 2. Moderate or severe aortic regurgitation development showed a tendency to association with higher increase in dimension of proximal ascending aorta. 3. No association was found between aneurysm and aortic regurgitation development. CONCLUSIONS: Patients operated for type A aortic dissection had a high incidence of late complications which lead to reoperation and in some cases death. The presence of a residual flap, increased aortic dimensions and higher increase rate of aortic dimensions were associated with a complicated evolution. MRI was a very useful technique for long-term monitoring and to identify prognostic indexes of evolution.     

Inactive dumps in Santa Catarina's carboniferous area: analysis of risks to the public health and the environment

The existence of inactive dumps considerably increases the so-called "environmental liability"; so much so that the final destination of urban solid residues takes a prominent place on the list of environmental issues of societies(1). In the state of Santa Catarina, it can be said that, currently, the real conditions of the "final destination deposits", or simply the inactive dumps, is officially unknown. This is maybe most evident in the carboniferous area of the state that already suffers from the environmental impact of coal mining. This study attempts to make a survey of the inactive dumps in the carboniferous area of Santa Catarina, analysing the risks they represent to public health and to the environment. The results gathered show that, of the eleven municipal districts in the carboniferous area, nine have inactive dumps. In these nine districts, there are eleven inactive dumps that, according to the this evaluation, represent a large risk to public health and the environment when the parameters analysed are taken into acount.     

The pedagogical practice of nursing teachers and their knowledge

This article has as objectives investigate the faculty knowledge that embase the pedagogical practice of the nursing-professors, glimpsing to understand the meaning of this social practice in what it refers to the process to become a professional professor. The qualitative nature study, with methodological emphasis in verbal story, used as instruments of data collection semi-arranged interviews, and the data analysis starting from the content analysis. Among the results obtained from the analysis, it has proven that the faculty knowledge and the pedagogical practice positively incises for the consolidation of the process to become professional professor in the scope of the faculty in the nursing course at UFPI.     

First report of diffuse cutaneous leishmaniasis and Leishmania amazonensis infection in Rio de Janeiro State, Brazil

Diffuse cutaneous leishmaniasis (DCL) is characterised by multiple and progressive cutaneous lesions, resistance to chemotherapy and Leishmania-specific T-cell anergy. We report the first autochthonous DCL case and the first human infection with Leishmania amazonensis in Rio de Janeiro State, Brazil, where only L. braziliensis is considered to be the causative agent of cutaneous leishmaniasis. Leishmania amazonensis was identified by multilocus enzyme electrophoresis and PCR-RFLP. Our case was diagnosed as DCL according to clinical, parasitological, histopathological and immunological criteria. These observations indicate that L. amazonensis is increasing its geographical distribution in Brazil, accounting for unusual clinical presentations in new transmission areas.     

Peripheral neurobiologic mechanisms of antiallodynic effect of warm water immersion therapy on persistent inflammatory pain

Water immersion is widely used in physiotherapy and might relieve pain, probably by activating several distinct somatosensory modalities, including tactile, pressure, and thermal sensations. However, the endogenous mechanisms behind this effect remain poorly understood. This study examined whether warm water immersion therapy (WWIT) produces an antiallodynic effect in a model of localized inflammation and whether peripheral opioid, cannabinoid, and adenosine receptors are involved in this effect. Mice were injected with complete Freund's adjuvant (CFA; intraplantar; i.pl.). The withdrawal frequency to mechanical stimuli (von Frey test) was used to determine 1) the effect of WWIT against CFA‐induced allodynia and 2) the effect of i.pl. preadministration of naloxone (a nonselective opioid receptor antagonist; 5 µg/paw), caffeine (a nonselective adenosine receptor antagonist; 150 nmol/paw), 1,3‐dipropyl‐8‐cyclopentylxanthine (DPCPX; a selective adenosine A₁ receptor antagonist; 10 nmol/paw), and AM630 (a selective cannabinoid receptor type 2 antagonist; 4 µg/paw) on the antiallodynic effect of WWIT against CFA‐induced allodynia. Moreover, the influence of WWIT on paw inflammatory edema was measured with a digital micrometer. WWIT produced a significant time‐dependent reduction of paw inflammatory allodynia but did not influence paw edema induced by CFA. Naloxone, caffeine, DPCPX, and AM630 injected in the right, but not in the left, hind paw significantly reversed the antiallodynic effect of WWIT. This is the first study to demonstrate the involvement of peripheral receptors in the antiallodynic effect of WWIT in a murine model of persistent inflammatory pain. © 2014 Wiley Periodicals, Inc.     

Structural Reorganization in the Supraoptic Nucleus of Withdrawn Rats following Long-Term Alcohol Consumption

We have recently shown in the supraoptic nucleus (SON) of the rat that prolonged ethanol consumption induces cell degeneration and enlargement of the surviving neurons and of their subcellular organelles. We analyzed the SON of withdrawn rats to evaluate whether it displays any evidence of morphological reorganization following abstinence from ethanol, inasmuch as in this condition the ethanol-Induced changes in the plasma levels of neurohormones and plasma osmolality are no longer detectable. A group of 18 month-old withdrawn rats was compared with age-matched, pair-fed control and ethanol-treated rats. To differentiate between the effects of withdrawal and the effects of rehydration, a group of 18-month-old rehydrated rats was also included in this study and compared with age-matched, pair-fed control and dehydrated rats. We estimated the volume of SON, and the total number and mean volume of its neurons. The cross-sectional areas of the vasopressinergic and oxytocinergic populations were also evaluated. At the ultra-structural level, we determined the volumes and surface areas of the rough endoplasmic reticulum and Golgi apparatus, and the volumes of neurosecretory granules and nucleoli. In withdrawn animals, the total number of SON neurons was smaller than in controls, although the neuronal volume was greater. The number of SON neurons did not differ between withdrawn and ethanol-treated rats, despite the reduced volume of SON the former animals. The decrease of SON volume correlated with and was caused by a reduction in the volume of SON neurons and in the size of the organelles involved in neuro-hormone synthesis. Thus, withdrawal from ethanol stops the ethanol-Induced neuronal degeneration of the SON and partially reverses the ethanol-induced enlargement of SON neurons and their organelles. We suggest that the larger volume of SON neurons in with dawn animals relative to controls represents a compensatory mechanism, triggered by the reduced number of neurons, to allow the maintenance of adequate levels of circulating neurohormones.     

Prolonged alcohol intake leads to irreversible loss of vasopressin and oxytocin neurons in the paraventricular nucleus of the hypothalamus

Previous data revealed that numerous neurons in the supraoptic nucleus degenerate after prolonged ethanol exposure, and that the surviving neurons increase their activity in order to prevent dramatic changes in water metabolism. Conversely, excess alcohol does not induce cell death in the suprachiasmatic nucleus, but leads to depression of neuropeptide synthesis that is further aggravated by withdrawal. The aim of the present study is to characterize the effects of prolonged ethanol exposure on the magnocellular neurons of the paraventricular nucleus (PVN) in order to establish whether or not magnocellular neurons display a common pattern of reaction to excess alcohol, irrespective of the hypothalamic cell group they belong. Using conventional histological techniques, immunohistochemistry and in situ hybridization, the structural organization and the synthesis and expression of vasopressin (VP) and oxytocin (OXT) in the magnocellular component of the PVN were studied under normal conditions and following chronic ethanol treatment (6 or 10 months) and withdrawal (4 months after 6 months of alcohol intake). After ethanol treatment, there was a marked decrease in the number of VP- and OXT-immunoreactive magnocellular neurons that was attributable to cell death. The surviving neurons were hypertrophied and the VP and OXT mRNA levels in the PVN unchanged. Withdrawal did not alter the number of VP- and OXT-producing neurons or the gene expression of these peptides. These results substantiate the view that after prolonged ethanol exposure numerous neurons of the hypothalamic magnocellular system degenerate, but the mRNA levels of VP and OXT are not decreased due to compensatory changes undergone by the surviving neurons.     

Special program to reduce cardiology consultation waiting lists: report on an innovatory experience.

The problem of waiting lists has been widely debated in the Portuguese society. In this paper, the authors report the first results of a prioritization approach, started in March 2000. In this program cardiologists and general practitioners work in close proximity, coordinating efforts in order to improve the establishment of clinical priorities, and consequently optimize hospital referral. Working as cardiology consultants, the authors were able to reduce the number of first consultation requests by 77.9% (December 2002). For the first time it was possible to match the number of requests with the available consultation times, halting the growth of the waiting list.