Mortality and survival in aortic arch surgeries with preservation of supra-aortic vessels: thirteen years of experience / Mortalidade e sobrevida em cirurgias do arco aórtico com preservação de vasos supra-aórticos: treze anos de experiência

Background: The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and mediumterm mortality rates of patients undergoing this surgical strategy is uncertain. Objectives: To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time. Methods: Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test. Results: In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance. Conclusions: There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B

Alterações hepáticas de abortos e lactentes de mães com HIV / Hepatic changes in abortions and infants from HIV-positive mothers

São poucos os trabalhos relacionados à investigação das alterações anatomopatológicas das lesões hepáticas em necropsias de abortos, natimortos e crianças procedentes de mães HIV positivas. Objetivo: Descrever as alterações hepáticas em fetos e lactentes procedentes de mães HIV positivas, sob o ponto de vista anatomopatológico, correlacionando-as ao HIV, aos agentes etiológicos causadores de infecções oportunistas e às drogas utilizadas nos diferentes esquemas terapêuticos. Métodos: O material utilizado foi proveniente de 15 necropsias de crianças e 5 abortos realizadas pelo Serviço de Anatomia Patológica do Hospital Universitário Antônio Pedro, da Universidade Federal Fluminense, no período de 1986 a 2007. As definições de aborto e lactentes seguem os critérios adotados pela Organização Mundial da Saúde. Foram realizados estudos macroscópicos e microscópicos de fígado, após inclusão em parafina utilizando os corantes hematoxilina e eosina e outros métodos de coloração especial (ácido periódico de Schiff, reticulina, trinômio de Gomory, prata metanamina e Sudan). As necropsias foram completas. Resultados: Foram observadas alterações macroscópicas em 13 casos, em pelo menos um critério, alterações microscópicas compatíveis com esteatose foram observadas em 12, necrose em 7 e colestase em 4 das crianças e natimortos. Dos cinco casos de abortos, dois foram procedentes de mães em tratamento com zidovudina. Todos apresentaram agentes de infecções oportunistas. Conclusão: As alterações hepáticas macroscópicas e microscópicas são importantes nesses pacientes, e parecem não estar relacionadas à alta frequência de infecções oportunistas. Este estudo fornecerá subsídios para a compreensão da patogenia dos acometimentos hepáticos causados pelo vírus HIV, agentes oportunistas e drogas utilizadas na terapia.

There are a few works in the literature concerning pathological and anatomical alterations of hepatic lesions in necropsies of aborts, stillbirths and children from HIV-positive mothers. Objective: To report pathological and anathomical hepatic alterations in fetus and infants from HIV-positive mothers, correlating them with HIV infections, etiologic agents of opportunistic infections and drugs used in different treatments. Methods: necropsy material from 15 children and 5 aborts was obtained from the Department of Pathology, Hospital Universitário Antônio Pedro, Fluminense Federal University, from 1986 to 2007. Aborts, stillbirths and children definitions followed World Health Organization criteria. Macro- and microscopic studies were performed after parafin inclusion with hematoxilin-eosin and other methods (periodic acid-Shiff, reticulin, Gomory's trichrome, silver methenamine, and Sudan stains). All necropsies were completed. Results: Results showed macroscopic changes in 13 cases, at least in one category, and microscopic changes compatible with esteatosis in 12 cases, necrosis in 7 cases, and colestasis in 4 children and stillbirths. Out of five abortions, two were due to mothers using zidovudina. All patients showed opportunistic infection. Conclusion: Macroscopic and microscopic hepatic changes are important in these patients and may not be related to the high frequency of the opportunistic infections. This study will provide subsidies for understanding the pathogenesis of hepatic problems caused by HIV virus, opportunistic agents and drugs used in therapy.