ABSTRACT
Cirrhotic cardiomyopathy historically has been confused as alcoholic cardiomyopathy. The key points for diagnosis of cirrhotic cardiomyopathy have been well explained, however this entity was neglected for a long time. Nowadays the diagnosis of this entity has become important because it is a factor that contributes significantly to morbidity-mortality in cirrhotic patients. Characteristics of cirrhotic cardiomyopathy are a hyperdynamic circulatory state, altered diastolic relaxation, impaired contractility, and electrophysiological abnormalities, particularity QT interval prolongation. The pathogenesis includes impaired function of beta-receptors, altered transmembrane currents and overproduction of cardiodepressant factors, such as nitric oxide, cytokines and endogenous cannabinoids. In addition to physical signs of hyperdynamic state and heart failure under stress conditions, the diagnosis can be done with dosage of serum markers, electrocardiography, echocardiography and magnetic resonance. The treatment is mainly supportive, but orthotopic liver transplantation appears to improve this condition although the prognosis of liver transplantation in patients with cirrhotic cardiomyopathy is uncertain.
Subject(s)
Humans , Liver Cirrhosis/complications , Cardiomyopathies/etiology , Liver Cirrhosis/physiopathology , Liver Cirrhosis/therapy , Cardiomyopathies/physiopathology , Cardiomyopathies/therapyABSTRACT
Abstract The aim of this study was to describe the first records of termite activity on non-fossilized human bones in Brazil. The cases reported in this study resulted from forensic analysis of six human skeletons found in northeastern Brazil between 2012 and 2014. Traces of tunnels and nests commonly produced by termites were found on several human bone surfaces as well as the specimens and characteristic signs of osteophagic activity. In four cases, the species were identified: Amitermes amifer Silvestri, 1901, Nasutitermes corniger (Motschulsky, 1855) (on two skeletons), and Microcerotermes indistinctus Mathews, 1977. In two other cases, the activity of termites on bone surfaces was evidenced by remains of nests and tunnels produced by these insects. At least in the samples of human remains available for this report, the number of termites collected was greater on bones found during autumn, the rainy season in the Northeast of Brazil. The human bones examined showed termites like insects with lots of strength at bone degradation, capable of continuing the process of decomposition of human remains even in completely skeletonized bodies.
Resumo O objetivo deste estudo foi descrever os primeiros relatos de atividade de térmitas em ossos humanos não fossilizados, no Brasil. Os casos relatados neste estudo resultaram da análise pericial de seis esqueletos humanos encontrados no Nordeste do Brasil, entre os anos de 2012 e 2014. Vestígios de túneis e ninhos comumente produzidos por cupins foram encontrados em várias superfícies dos ossos humanos, bem como a presença de espécimes e característicos sinais de atividade osteofágica. Em quatro casos, foram identificadas as espécies: Amitermes amifer Silvestri, 1901, Nasutitermes corniger (Motschulsky, 1855) – em duas ossadas, e Microcerotermes indistinctus Mathews, 1977. Em dois outros casos, a atividade de cupins sobre superfícies ósseas foi evidenciada pelos restos de ninhos e túneis produzidos por esses insetos. Pelo menos nas amostras de restos humanos disponíveis para o presente estudo, o número de térmitas recolhido foi maior em ossos encontrados durante o outono, a estação chuvosa no Nordeste do Brasil. Os ossos humanos analisados apresentaram cupins como insetos com muita força na degradação óssea, com capacidade de prosseguir o processo de decomposição de restos humanos, mesmo em corpos completamente esqueletizados.
Subject(s)
Humans , Animals , Bone and Bones , Isoptera , Postmortem Changes , BrazilABSTRACT
As infeccoes do esterno e/ou cartilagens costais apos cirurgia plastica cardiaca nao sao frequente mas quando ocorrem tem dificil tratamento.Sao estudados 12 pacientes portadores dessa infeccao, tratados no Instituto de Doencas Cardiopulmonares E.J. Zerbini, e apresentados os resumos da evolucao de tres desses pacientes para melhor exemplificar as condutas terapeuticas. Os germes causadores mais comuns sao bacterias hospitalares cujo controle antibiotico nem sempre e eficaz. Sao analisados os exames complementares que podem ser usados para localizacao das areas comprometidas.As bases do tratamento constam da retirada completa dos tecidos infectados juntamente com antibioticoterapia local e sistemica. Algumas vezes e necessaria mais de uma intervencao cirurgica para obter a cura