HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

PTEN loss in Gleason grade 7 prostate tumors exhibits intratumoral heterogeneity and is associated with unfavorable pathological features

Background: PTEN loss is observed in 20­30% of prostate cancers and is associated with a poor outcome, but clinical details of the impact of this biomarker are unclear for intermediate grade tumors. Methods: We investigated 43 radical prostatectomy-derived grade 7 prostate tumors from the Clinics Hospital of Ribeirão Preto. Tissue microarray (TMA) blocks were constructed and PTEN copy number status was determined for all patients through fluorescence in situ hybridization (FISH). To determine the presence of PTEN protein loss in our study cohort, we performed immunohistochemistry (IHC) in TMA sections. We then developed an automated algorithm in HALO™ to identify regions of PTEN protein loss in whole prostate scanned sections from ten patients with known PTEN deletion status by FISH. Clinical analyses were conducted to determine the associations between PTEN loss and patient outcome. All statistical analyses were conducted in R v3.4.3 with P-values below 0.05 being considered statistically significant. Results: In this study of 43 grade 7 tumors, we found PTEN deletions by FISH in 18.9% of tumors, and PTEN protein loss by IHC in 16.3% of tumors. Both techniques were highly concordant and complementary. Clinical analysis demonstrated that PTEN deletion by FISH was significantly associated with positive margin invasion (P = 0.04) and Gleason score upgrade (P = 0.001). Digital image analysis of ten representative tumors demonstrated distinct intratumoral heterogeneity for PTEN protein loss in four tumors. Conclusions: This study shows that PTEN loss in Gleason grade 7 tumors can be heterogeneous and that a systematic analysis of this biomarker using a combination of FISH, IHC, and digital imaging may identify patients with a greater risk of poor outcome (AU)

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

Effects of the essential oil of Lippia gracilis Schauer on caulinary shoots of heliconia cultivated in vitro / Efeito do óleo essencial de Lippia gracilis Schauer sobre ápices caulinares de heliconia cultivadas in vitro

The effects of thymol and carvacrol and the essential oil of Lippia gracilis on caulinary shoots of heliconia were evaluated. After disinfection, the shoots were inoculated into MS medium and subjected to the treatments with 420 µL L-1 of essential oil (EO) of L. gracilis; 420 µL L-1 of thymol; 420 µL L-1 of carvacrol; 210 µL L-1 of thymol and 210 µL L-1 of carvacrol. The control treatment consisted of the MS medium without any phytoregulators. The main components of EO from L. gracilis are carvacrol, ρ-cimene, and thymol. Seven days after the initiation of the experiments, 36.3% of the control treatment shoots were necrotized, but 90% of the caulinary shoots exposed to EO, thymol, or carvacrol appeared necrotized. Transmission electron microscopy of the shoots revealed that the treatment with EO, thymol, or carvacrol caused the destruction of the plasma cell membranes, and the cell organelles and the nucleus were hardly evident. The EO and its main constituent were toxic to caulinary shoots of heliconia.

O efeito do timol, carvacrol e óleo essencial de Lippia gracilis foi observado sobre ápices caulinares de heliconia. Após a desinfestação os ápices foram inoculados em meio MS com os tratamentos de 420 µL L-1 do óleo essencial (OE) de L. gracilis; 420 µL L-1 de timol; 420 µL L-1 de carvacrol; 210 µg L-1 de timol e 210 µL L-1 de carvacrol. O tratamento controle consistiu de meio MS sem fitorreguladores. Os principais componentes do OE foram carvacrol, ρ-cimeno e timol. Sete dias após o início do experimento 36,3% dos ápices submetidos ao tratamento controle e 90% dos ápices caulinares expostos ao EO, timol ou carvacrol necrosaram. A microscopia eletrônica de transmissão dos ápices caulinares revelou que os tratamentos com OE, timol e carvacrol provocaram desestruturação da membrana plasmática das células. As organelas e o núcleo não estavam evidentes. O OE e seus principais constituintes foram tóxico para os ápices caulinares de helicônias.

Estabelecimento de protocolo para micropropagação de Lippia gracilis Schauer / Establishment of protocol for Lippia gracilis Schauer micropropagation

A espécie Lippia gracilis SCHAUER (Verbenaceae) é nativa do Nordeste brasileiro e se destaca pela capacidade de acumular nos tricomas glandulares óleos essenciais com atividade antimicrobiana. Tendo em vista que não constam trabalhos na literatura sobre o estabelecimento in vitro dessa espécie, este trabalho teve como objetivo estabelecer protocolo para micropropagação de L. gracilis. Para tanto, ramos contendo folhas foram coletados de plantas matrizes no habitat natural para a confecção de estacas. Em laboratório, os explantes provenientes do processo de estaquia foram assepticamente tratados e inoculados em meio MS, acrescido de fitorreguladores, com o intuito de se estabelecer a melhor dose para o desenvolvimento dos explantes. Em decorrência de altos níveis de contaminação, avaliou-se o efeito da cefalexina. No entanto, apesar do antibiótico ter apresentado diminuição na contaminação bacteriana, a porcentagem de oxidação foi elevada. Portanto, testou-se o carvão ativado, ácido ascórbico, ácido cítrico e metade dos sais de MS quanto a eficiência no controle da oxidação. Concluiu-se que, o antibiótico na concentração utilizada provocou a oxidação dos explantes e os fitorreguladores, bem como os métodos antioxidantes testados, não apresentaram resultados consistentes para o melhor desenvolvimento dos explantes e controle da oxidação, respectivamente.

The species Lippia gracilis Schauer (Verbenaceae) is native to Northeastern Brazil and has been important for its ability to accumulate essential oils with antimicrobial activity in the glandular trichomes. Since there are no reports in the literature on the micropropagation of this species, the present work aimed to establish a protocol for L. gracilis micropropagation. Thus, branches containing leaves were collected from plant matrices in their natural habitat to prepare cuttings. In the laboratory, explants from cutting were aseptically treated and inoculated onto MS medium plus plant growth regulators in order to establish the best dose for the development of explants. Due to high levels of contamination, the effect of cephalexin was evaluated. Although the antibiotic decreased the bacterial contamination, the percentage of oxidation was high. Then, activated charcoal, ascorbic acid, citric acid and half the salts of MS were tested for their effectiveness to control oxidation. In conclusion, the used antibiotic concentration resulted in oxidation of explants. Furthermore, plant growth regulators and antioxidant methods did not show consistent results for a better development of explants and control of oxidation, respectively.

Adaptações fisiológicas e anatômicas de melissa officinalis L. (Lamiaceae) cultivadas sob malhas termorrefletoras em diferentes intensidades luminosas / Physiological and morphological adaptations of melissa officinalis L. (Lamiaceae) cultivated under thermo-reflector shading nets at different luminous intensities

Objetivou-se, com a realização da pesquisa, avaliar modificações fisiológicas e anatômicas em plantas de melissa, cultivadas sob malhas termorrefletoras (Aluminet®), em diferentes níveis de sombreamento, visando conhecer a plasticidade fenotípica em resposta de adaptação a diferentes quantidades de luz. Os tratamentos foram caracterizados por plantas submetidas a pleno sol e a 20 e 60 por cento de intensidade luminosa, e arranjados conforme o delineamento inteiramente casualizado (DIC). As quantificações de clorofila foram feitas em quatro repetições, as medições das epidermes e parênquimas foram repetidas 15 vezes e utilizou-se 10 repetições para as avaliações das características de cloroplastos e grãos de amido destes. Plantas submetidas a 20 por cento de intensidade luminosa apresentaram maior quantidade de clorofila a e, portanto, maior razão clorofila a/b. Comparativamente, as folhas de melissa a pleno sol e a 60 por cento de luz apresentaram células da epiderme adaxial mais espessas, mas as células da epiderme abaxial mostraram características encontradas em folhas de sombra, ou seja, mais finas. Quanto maior a intensidade luminosa, maior o número de cloroplastos, porém, a pleno sol mostraram-se mais finos e com menor área. Os grãos de amido de plantas cultivadas sob ambientes sombreados tiveram maior área e ocuparam maior parte nos cloroplastos de plantas a 60 por cento de intensidade luminosa. Assim, plantas de melissa, quando submetidas ao sombreamento, tiveram plasticidade fenotípica.

The aim of this study was to evaluate physiological and anatomical modifications in lemon balm plants, cultivated under thermo-reflector nets (Aluminet®) at different levels of shading, in order to understand the phenotypic plasticity in adaptation response to different light quantities. The treatments were characterized by plants subjected to full sun and 20 and 60 percent of luminous intensity, and arranged in completely randomized design (CRD). The quantifications of chlorophylls were done in four replicates, the measurements of epidermis and parenchymas were repeated 15 times and 10 replicates were used to evaluate characteristics of chloroplasts and their starch grains. Plants subjected to 20 percent of luminous intensity showed higher quantity of chlorophyll a and, therefore, higher chlorophyll a/b ratio. Lemon balm leaves under full sun and 60 percent of light showed thicker adaxial epidermis cells, but the abaxial epidermis cells showed characteristics found in shaded leaves, i.e., they were slender. The higher the light intensity, the larger the number of chloroplasts; however, under full sun, they were slender and had smaller area. The starch grains of leaves grown under shaded environments showed larger area and, at 60 percent of luminous intensity, occupied the largest part of chloroplasts. Thus, lemon balm plants, subjected to shading conditions, showed phenotypic plasticity.

Ocorrência de Hepatozoon spp. (Apicomplexa, Hepatozoidae) em serpentes do gênero Bothrops de cativeiro / Occurrence of Hepatozoon spp. (Apicomplexa, Hepatozoidae) in snakes of genus Bothrops in captivity

The occurrence of Hepatozoon gamont in the blood cells of Bothrops jararaca and B. jararacussu in captivity was analyzed. The prevalence of infection by Hepatozoon spp. was 50 percent and few erythrocytes contained the gamonts. Results suggest that the infection by Hepatozoon spp. occurred in the natural environment or after the captivity.

Achados timpanométricos em neonatos com emissões otoacústicas presentes: medidas e interpretações / Tympanometry in neonates with normal otoacoustic emissions: measurements and interpretation

Timpanometria avalia condições funcionais da orelha média. Quando realizada em neonatos abaixo de quatro meses de idade pode gerar dúvidas. Sondas de alta freqüência têm sido investigadas na busca por resultados mais confiáveis. OBJETIVO: Descrever e analisar interpretações de características e medidas obtidas na timpanometria em neonatos com freqüências de 226, 678 e 1000Hz. MATERIAL E MÉTODO: Os 110 neonatos avaliados tinham idade entre 6 e 30 dias, não apresentaram fatores de risco e tinham emissões otoacústicas presentes. A timpanometria foi realizada com o analisador GSI-33-II, na Divisão de Educação e Reabilitação dos Distúrbios da Comunicação, São Paulo, em 2004. FORMA DE ESTUDO: Clínico prospectivo. RESULTADOS: Observou-se equilíbrio nas curvas pico único e pico duplo em 226Hz, maior ocorrência de assimétrica em 678Hz e de pico único em 1000 Hz. Houve significância de gênero na medida volume equivalente do meato acústico externo, em 226Hz, e na medida admitância acústica estática de pico compensado, em 1000Hz. O protocolo inglês apresentou quase 100 por cento de normalidade em 678 e 1000Hz. CONCLUSÃO: A sonda de 1000Hz apresentou melhores resultados na caracterização da normalidade. O protocolo inglês mostrou-se eficiente em diminuir variabilidades das medidas. Os resultados podem ser usados como guia no diagnóstico da timpanometria.

Tympanometry is used in evaluating middle ear functional conditions. Before six months of age its results may be misleading. High frequency studies aim to provide more valid procedures. AIM: To describe and discuss tympanometric measurements and the interpretation in normal hearing neonates at 226, 678 and 1000Hz. METHOD: 110 neonates that were analyzed had normal otoacoustic emissions and no risk for hearing impairment. The age range was 6 to 30 days. Curves were obtained using the GSI-33-II, at the Divisão de Educação e Reabilitação dos Distúrbios da Comunicação, São Paulo, in 2004. STUDY DESIGN: Clinical prospective. RESULTS: There was a balance between single and double peak curves at 226Hz. Most of the curves were asymmetric at 678Hz, and single-peaked at 1000Hz. quantitative measurements showed a significant gender difference in the Equivalent Ear Canal Volume at 226Hz and on the Peak Compensated Static Acoustic Admittance at 1000Hz. The English protocol showed that almost 100 percent of ears were normal at 678 and 1000Hz. CONCLUSION: 1000Hz yielded superior results for characterizing normality. The English protocol was efficient to reduce the variability of tympanometric measurements. Data from this study may be used as a guide for diagnosis using tympanometry in neonates.

Histological and biochemical effects induced by sublethal doses of Bothrops jararacussu venom in mice

Snake venom is characterized by hemorrhagic, coagulant, proteolytic and myotoxic activities which in Bothrops jaracussu venom are related to intraspecific variations. In the present study, female Swiss mice were divided into two groups: treated with 25æg or 50æg venom. These were subdivided into three groups of six animals each, according to blood collection: 2, 4 or 24h after venom injection. Animals were anesthetized using diethyl-ether inhalation and 1ml of blood was collected by heart puncture. Then, the following organs were removed: spleen, skeletal muscle, kidneys, liver and lungs; histological sections were obtained and stained with hematoxylin-eosin (HE). The following biochemical parameters were analyzed: aspartate aminotransferase (AST/GOT), alanine aminotransferase (ALT/GPT), total lactate dehydrogenase (LDH), glucose, creatinine and urea levels, and total protein content. Results showed significant alterations in AST, LDH, glucose and urea levels, and total protein content, as well as important tissue alterations in the liver, kidneys and lungs. It could be concluded that, even using sublethal doses of venom, there were significant changes in almost all the tested biochemical parameters as well as tissue alterations in the kidneys and lungs.(AU)

Valor do precondicionamento isquêmico na circulaçäo colateral, funçäo ventrícular e evoluçäo clínica no infarto agudo do miocárdio / The effecft of ischemic preconditioning on collateral circulation, ventricular function and clinical outcomes after acute

Objetivo - Avaliar a influência do precondicionamento isquêmico no fenômeno do desenvolvimento de circulaçäo colateral (CC), na funçäo ventrícular precoce e na evoluçäo hospitalar de pacientes com infarto agudo do miocárdio (IAM). Métodos - Foram estudados 97 pacientes com IAM anterior nas primeiras 6h, com oclusäo proximal da artéria coronária descendente anterior e divididos em 2 grupos na dependência da presença (GA) ou ausência (GB) de angina precedendo o IAM. Coronariografia e ventriculografiaoram realizadas nas primeiras 6h , antes de qualquer tentativa de reperfusäo. A fraçäo de ejeçäo global do ventrículo esquerdo (FEVE), foi obtida através do método de áreas e a funçäo regional da parede anterior anterior através da linha do centro. Resultados - Os grupos foram superponíveis em relaçäo ao sexo, idade, pico de CKMB, tratamento instituído (perfusäo química ou mecânica) e sucesso na reperfusäo. A média da FEVE e a mobilidade da parede anterior foram similares nos 2 gupos, respectivamente, 3+_9 por cento e -2,55+/_1,17 dp/corda no GA e 37 por cento+/_8 por cento e -2,75+/_0,79 dp/corda no GB (p=ns). A CC esteve presente em 6 pacientes do GA e em 8 do GB (p=ns). A evoluçäo clínica foi melhor no GA (todos Killip classe 1) em comparçäo ao GB (8 pacientes Killip > ou igual a 2) p=0,007. Conclusäo - Embora näo exista diferença entre os grupos em relaçäo a presença de CC, funçäo ventricular e regional do ventrículo esquerdo, a presença de angina precedendo o infarto associado à melhor evoluçäo hsptalar, a qual poderia em parte ser explicada pelo fenômeno denominado precondicionamento esquêmico.

Análise da retração elástica nos primeiros 15 minutos após angioplastia coronária por cateter balão / Elastic recoil in the firt 15 minutes following a successfull balloon angioplasty

Objetivo - Determinar angiograficamente a retraçäo elástica (RE) nos primeiros 15 minutos após angioplastia coronária (AC) por cateter baläo. Métodos - E um estudo prospectivo, 154 pacientes, portadores de angina estável, foram submetidos a AC com sucesso. Realizaram-se angiografias imediatamente após a última insuflaçäo com sucesso e aos 5,10 e 15 min. Na análise quantitativa utilizou-se caliper eletrônico. Quantificaram-se o diâmetro luminal mínimo (DLM) e a RE no controle imediato, aos 5, 10 e 1min. Relacionaram-se a magnitude da RE e o DLM com as características angiográficas da lesäo tratada, com o diâmetro do baläo e com o grau de lesäo residual imediatamente após a AC. Resultados - O diâmetro de referência médio do vaso foi de 3,09+/_0,61 mm e o diâmetro do baläo de 2,95+/_0,52 mm. O DLM mínimo pré dilataçäo foi de 0,65+/_0,42 mm, atingindo 2,23+/_0,55 mm após a dilataçäo (p<0,0001), decrescendo para 2,09+/_0,47 mm e 5 min (p<0,0001), 2,01+/_0,47 mm em 10 min (p<0,0001) e para1,91+/_0,56 mem 15 min. (p<0,0001). A RE aumentou progressivamente, atingindo 34,29+/_20,40 por cento aos 15 min. Nos vaso tratados onde a relaçäo baläo/artéria < ou igual a 1 a RE foi de 0,90+/_0,74 mm em 15 min. e de 1,20+/_0,50 mm quando a relaçäo foi >1 (p<0,0001). Identificou-se maior RE nos primeiros 15 min. no grupo de pacientes onde a lesäo residual no controle imediato situou-se entre 30 a 50 por cento do que no grupo onde a lesäo residual foi < 30 por cento. Conclusäo - A RE é um fenômeno dinâmico e progrssvo que ocorre dentro de 15 min. após a AC com sucesso. Determinou reduçäo média de 34,29+/_20,40 por cento no diâmetro do vaso em 15 min. e é maior quando a relaçäo baläo/artéria é >1. A lesäo residual que situa entre 30 e 50 por cento no controle angiográfico imediato é fator preditor de maior RE ao longo dos 15 min.

Prolapso de mucosa uretral em meninas / Urethral Mucosa Prolapse

Entre janeiro de 1985 e dezembro de 1993 foram tratadas seis meninas com prolapso de mucosa uretral através da exérese cirúrgica de prolapso e ampliaçäo do meato uretral externo. A patologia predominou em criança de pele negra e classe social baixa. Os principais sintomas e sinais foram sangramento vaginal e tumores a nível do meato uretral externo. Os resultados, com seguimento de um mês, três meses, nove meses, 12 meses e 24 meses foram excelentes

Hérnia hiatal e esofagite de refluxo: estadiamento endoscópico da doença do refluxo gastroesofágico / Hiatal hernia and reflux esophagitis: endoscopic stading of gastro-esophageal reflux disease

A hérnia hiatal por deslizamento foi disposta em hérnia de pequeno, médio e grande tamanho, de acordo com a extensäo do segmento prolapsado através do orifício diafragmático. Hérnia hiatal de pequeno tamanho foi assim considerada quando só havia herniaçäo da PARS ABDOMINALIS, isto é, da porçäo abdominal do esôfago. Na hérnia hiatal de médio tamanho, a porçäo herniada contém também a PARS CARDIACA do estômago, havendo cerca de 30 a 40mm de mucosa gástrica acima do pinçamento diafragmático. Na hérnia hiatal de grande tamanho, a porçäo herniada contém també o FUNDUS VENTRICULI, havendo 50mm ou mais de mucosa gástrica dentro da cavidade torácica. Em 1.000 esofagogastroduodenoscopias sucessivas, a hérnia hiatal por deslizamento foi diagnosticada em 207 pacientes. A esofagite de refluxo histológica esperada incidiu em 51,2% dos casos de hérnia, sendo sua prevalência de 32,8% nas hérnias de pequeno.tamanho com PA com 10mm, de 53,3% nas hérnias de pequeno tamanho com PA com 15-20mm, e de 79% nas hérnias de médio tamanho. A prevalência e a intensidade da esofagite de refluxo, bem como suas complicaçöes, estiveram diretamente relacionadas com as dimensöes da hérnia hiatal e com o grupo etário. A associaçäo com úlcera péptica gastroduodenal foi mais freqüente nos pacientes com hérnia de pequeno tamanho. O estadiamento tem por objetivo registrar a forma, clínica ou anatômica, em que se encontra uma entidade nosológica, em um determinado momento de sua fase evolutiva. Foi porposto o seguinte ...

Fio radiopaco para localização de pontes de safena / Radiopaque thread for localization of saphenous grafts

E apresentada uma tecnica simples e efetiva para marcacao do orificio de anastomose de pontes de safena na aorta. Consiste no aproveitamento do fio radiopaco que acompanha as gases cirurgicas comuns, que a fixado em torno da anastomose aortica