Trace mineral source influences digestion, ruminal fermentation, and ruminal copper, zinc, and manganese distribution in steers fed a diet suitable for lactating dairy cows.

High solubility of certain trace minerals (TM) in the rumen can alter nutrient digestibility and fermentation. The objectives of the present studies were to determine the effects of TM source on 1) nutrient digestibility and ruminal fermentation, 2) concentrations of soluble Cu, Zn, and Mn in the rumen following a pulse dose of TM, and 3) Cu, Zn, and Mn binding strength on ruminal digesta using dialysis against a chelating agent in steers fed a diet formulated to meet the requirements of a high producing dairy cow. Twelve Angus steers fitted with ruminal cannulae were adapted to a diet balanced with nutrient concentrations similar to a diet for a high producing lactating dairy cow for 21 d. Steers were then randomly assigned to dietary treatments consisting of 10 mg Cu, 40 mg Mn, and 60 mg Zn/kg DM from either sulfate (STM), hydroxychloride (HTM) or complexed trace minerals (CTM). The experimental design did not include a negative control (no supplemental Cu, Mn, or Zn) because the basal diet did not meet the National Research Council requirement for Cu and Zn. Copper, Mn, and Zn are also generally supplemented to lactating dairy cow diets at concentrations approximating those supplied in the present study. Following a 14-d adaptation period, total fecal output was collected for 5-d. Following the fecal collection period, rumen fluid was collected for Volatile fatty acid (VFA) parameters. On the following day, the same diet was provided for 14 d, without supplemental Cu, Zn, and Mn. This period served as a wash-out period. A pulse dose of 100, 400, and 600 mg of Cu, Zn, Mn, respectively, from either STM, HTM, or CTM, was administered via ruminal cannulae to the steers on day 15. Over a 24-h period ruminal samples were obtained every 2-h. Following centrifugation, the supernatant was analyzed for Cu, Mn, and Zn. Ruminal solid digesta samples from times 0, 12, and 24 h after bolus dosing were exposed to dialysis against Tris-EDTA. Digestibility of NDF and ADF were lesser in STM vs. HTM and vs. CTM supplemented steers. Steers receiving HTM and CTM had greater total VFA concentrations than STM, and molar proportions of individual VFA were not affected by treatment. Ruminal soluble Cu and Zn concentrations were greater post dosing in STM and CTM supplemented steers at 2, 4, and 6 h for Cu and 4, 6, 8, 10 and 12 h for Zn when compared to HTM supplemented steers. The release of Cu and Zn from ruminal solid digesta following dialysis against Tris-EDTA at 12 and 24 h postdosing was greater for steers receiving HTM compared to those receiving STM or CTM. Results indicate trace mineral source impacts: 1) how tightly bound Cu and Zn are to ruminal solid digesta; 2) fiber digestion; 3) and ruminal total VFA concentrations.

Effects of bacterial cultures, enzymes, and yeast-based feed additive combinations on ruminal fermentation in a dual-flow continuous culture system.

Bacterial cultures, enzymes, and yeast-derived feed additives are often included in commercial dairy rations due to their effects on ruminal fermentation. However, the effects of these additives when fed together are not well understood. The objective of this study was to evaluate the changes in ruminal fermentation when a dairy ration is supplemented with combinations of bacterial probiotics, enzymes and yeast. Our hypotheses were that ruminal fermentation would be altered, indicated through changes in volatile fatty acid profile and nutrient digestibility, with the inclusion of (1) an additive, (2) yeast, and (3) increasing additive doses. Treatments were randomly assigned to 8 fermenters in a replicated 4 × 4 Latin square with four 10 d experimental periods, consisting of 7 d for diet adaptation and 3 d for sample collection. Basal diets contained 52:48 forage:concentrate and fermenters were fed 106 g of dry matter per day divided equally between two feeding times. Treatments were: control (CTRL, without additives); bacterial culture/enzyme blend (EB, 1.7 mg/d); bacterial culture/enzyme blend with a blend of live yeast and yeast culture (EBY, 49.76 mg/d); and a double dose of the EBY treatment (2×, 99.53 mg/d). The bacterial culture/enzyme blend contained five strains of probiotics (Lactobacillus animalis, Propionibacterium freudenreichii, Bacillus lichenformis, Bacillus subtilis, and Enterococcus faecium) and three enzymes (amylase, hemicellulase, and xylanase). On d 8-10, samples were collected for pH, redox, volatile fatty acids, lactate, ammonia N, and digestibility measurements. Statistical analysis was performed using the GLIMMIX procedure of SAS. Repeated measures were used for pH, redox, VFA, NH3-N, and lactate kinetics data. Orthogonal contrasts were used to test the effect of (1) additives, ADD (CTRL vs. EB, EBY, and 2X); (2) yeast, YEAST (EB vs. EBY, and 2X); and (3) dose, DOSE (EBY vs. 2X). No effects (P > 0.05) were observed for pH, redox, NH3-N, acetate, isobutyrate, valerate, total VFA, acetate:propionate, nutrient digestibility or N utilization. Within the 24 h pool, the molar proportion of butyrate increased (P = 0.03) with the inclusion of additives when compared to the control while the molar proportion of propionate tended to decrease (P = 0.07). In conclusion, the inclusion of bacterial cultures, enzymes and yeast in the diet increased butyrate concentration; but did not result in major changes in ruminal fermentation.

Effects of calcium-magnesium carbonate and calcium-magnesium hydroxide as supplemental sources of magnesium on microbial fermentation in a dual-flow continuous culture.

Supplemental sources of Mg can also aid in ruminal pH regulation due to their alkaline properties. Magnesium oxide (MgO) is the most common source of Mg for ruminants and can help controlling ruminal pH; however, the alkaline potential of other sources of Mg has not been evaluated. We aimed to evaluate the inclusion of calcium-magnesium carbonate (CaMg(CO3)2) and calcium-magnesium hydroxide (CaMg(OH)4) alone or in combination as supplemental sources of Mg in corn silage-based diets and its impact on ruminal microbial fermentation. We hypothesized that inclusion of CaMg(OH)4 would allow for ruminal fermentation conditions resulting in a greater pH compared to the inclusion of CaMg(CO3)2. Four treatments were defined by the supplemental source of Mg in the diet: 1) Control (100% MgO, plus sodium sesquicarbonate as a buffer); 2) CO3 [100% CaMg(CO3)2]; 3) OH [100% CaMg(OH)4]; and 4) CO3/OH [50% Mg from CaMg(CO3)2, 50% Mg from CaMg(OH)4]. Nutrient concentration was held constant across treatments (16% CP, 30% NDF, 1.66 Mcal NEl/kg, 0.67% Ca, and 0.21% Mg). Four fermenters were used in a 4 × 4 Latin square design with four periods of 10 d each. Samples were collected for analyses of nutrient digestibility, soluble Mg, VFA, and NH3, while pH was measured at 0, 1, 2, 4, 6, 8, and 10 h post morning feeding to estimate % time when pH was below 6 (pH-B6) and area under the pH curve for pH below 6.0 (pH-AUC). Bacteria pellets were harvested for 15N analysis and estimates of N metabolism. Treatment effects were analyzed with the mixed procedure of SAS, while effects of using either CaMg(CO3)2 or CaMg(OH)4 as Mg source in comparison to Control treatment were evaluated by orthogonal contrasts. Similar pH-related variables were observed for Control, OH, and CO3/OH treatments, which had smaller pH-AUC and pH-B6 than CO3 (P ≤ 0.01). Butyrate molar proportion was greater in Control and CO3/OH than in CO3 and OH (P = 0.04). Orthogonal contrasts showed lower flow of bacterial N (P = 0.04), lower butyrate molar proportion (P = 0.08) and greater pH-AUC (P = 0.05) for diets with CaMg(CO3)2 in comparison with the Control. Concentration of soluble Mg in ruminal fluid (P = 0.73) and nutrient digestibility (P ≥ 0.52) were similar across treatments. Under the conditions of this experiment, using CaMg(OH)4 alone or combined with CaMg(CO3)2 allowed for a less acidic ruminal fermentation pattern than a diet with only CaMg(CO3)2.

Copper sulfate and sodium selenite lipid-microencapsulation modifies ruminal microbial fermentation in a dual-flow continuous-culture system.

Undesirable interactions between trace mineral elements and ruminal contents may occur during digestion when mineral salts are supplemented. Antimicrobial effects of copper sulfate (CuSO4) may affect ruminal digestibility of nutrients when fed as a source of copper (Cu), while sodium selenite (Na2SeO3) may be reduced in the rumen to less available forms of selenium (Se). Our objective was to evaluate if protection of CuSO4 and Na2SeO3 by lipid-microencapsulation would induce changes on ruminal microbial fermentation. We used 8 fermentors in a dual-flow continuous-culture system in a 4 × 4 duplicated Latin square with a 2 × 2 factorial arrangement of treatments. Factors were CuSO4 protection (unprotected and protected by lipid-microencapsulation) and Na2SeO3 protection (unprotected and protected by lipid-microencapsulation). Treatments consisted of supplementation with 15 mg/kg of Cu and 0.3 mg/kg of Se from either unprotected or protected (lipid-microencapsulated) sources, as follows: (1) Control (unprotected CuSO4 + unprotected Na2SeO3); (2) Cu-P (protected CuSO4 + unprotected Na2SeO3); (3) Se-P (unprotected CuSO4 + protected Na2SeO3); (4) (Cu+Se)-P (protected CuSO4 + protected Na2SeO3). All diets had the same nutrient composition and fermentors were fed 106 g of dry matter/d. Each experimental period was 10 d (7 d of adaptation and 3 d for sample collections). Daily pooled samples of effluents were analyzed for pH, NH3-N, nutrient digestibility, and flows (g/d) of total N, NH3-N, nonammonia N (NAN), bacterial N, dietary N, and bacterial efficiency. Kinetics of volatile fatty acids was analyzed in samples collected daily at 0, 1, 2, 4, 6, and 8 h after feeding. Main effects of Cu protection, Se protection, and their interaction were tested for all response variables. Kinetics data were analyzed as repeated measures. Protection of Cu decreased acetate molar proportion, increased butyrate proportion, and tended to decrease acetate:propionate ratio in samples of kinetics, but did not modify nutrient digestibility. Protection of Se tended to decrease NH3-N concentration, NH3-N flow, and CP digestibility; and to increase flows of nonammonia N and dietary N. Our results indicate that protection of CuSO4 may increase butyrate concentration at expenses of acetate, while protection of Na2SeO3 tended to reduce ruminal degradation of N. Further research is needed to determine the effects of lipid-microencapsulation on intestinal absorption, tissue distribution of Cu and Se, and animal performance.

Comparison of microbial fermentation data from dual-flow continuous culture system and omasal sampling technique: A meta-analytical approach.

Although the omasal sampling technique (OST) has been successfully used to estimate ruminal fermentation and nutrient flow, alternatives to invasive animal trials should be pursued and evaluated. The objective of this study was to evaluate carbohydrate and N metabolisms using a meta-analytical approach to compare 2 methods: dual-flow continuous culture system (DFCCS) and OST. To be included, studies needed to report diet chemical composition and report at least 1 of the dependent variables of interest. A total of 155 articles were included, in which 97 used the DFCCS and 58 used the OST. The independent variables used were dietary nonfiber carbohydrate concentration, neutral detergent fiber (NDF) degradability, true crude protein (CP) degradability, and efficiency of microbial protein synthesis (EMPS). In addition, 12 dependent variables were used. Statistical analyses were performed using the Mixed procedure of SAS (SAS Institute Inc., Cary, NC). A random coefficients model was used considering study as a random effect and including the possibility of covariance between the slope and the intercept. The effect of method (DFCCS or OST) was included and tested in the estimates of the intercept, linear, and quadratic effects of the independent variable. There was no method effect when NDF degradability was regressed with total volatile fatty acids concentration, true CP degradability, and EMPS. Molar proportions of acetate and propionate were quadratically associated with NDF degradability. When NDF degradability was regressed with acetate and propionate there was a method effect, differing only in the intercept (ß0) estimate. True organic matter digestibility, bacterial N/total N, efficiency of N utilization, total volatile fatty acid concentration, and molar proportion of butyrate linearly increased as dietary nonfiber carbohydrate concentration increased, and none of these variables were affected by method. Concentration of ammonia N had a linear and positive association with true CP degradability. This was the only variable that had a method effect when regressed with true CP degradability, differing only in the estimate of the intercept (ß0). As EMPS increased, efficiency of N utilization also increased, and it was affected by method. Overall, the majority of DFCCS responses were similar to OST. When a method effect was observed, it was mainly on the estimate of the intercept, demonstrating that the magnitude of these responses was different. However, the relationships between independent and dependent variables were similar across methods.

Effects of lipopolysaccharide dosing on bacterial community composition and fermentation in a dual-flow continuous culture system.

The objectives of this study were to evaluate the effects of lipopolysaccharide (LPS) dosing on bacterial fermentation and bacterial community composition (BCC), to set up a subacute ruminal acidosis (SARA) nutritional model in vitro, and to determine the best sampling time for LPS dosing in a dual-flow continuous culture system. Diets were randomly assigned to 6 fermentors in a replicated 3 × 3 Latin square with three 11-d experimental periods that consisted of 7 d for diet adaptation and 4 d for sample collection. Treatments were control diet (CON), wheat and barley diet (WBD) to induce SARA, and control diet + LPS (LPSD). Fermenters were fed 72 g of dry matter/d. The forage:concentrate ratio of CON was 65:35. The WBD diet was achieved by replacing 40% of dry matter of the CON diet with 50% ground wheat and 50% ground barley. The LPS concentration in LPSD was 200,000 endotoxin units, which was similar to that observed in cows with SARA. The SARA inducing and LPS dosing started at d 8. The BCC was determined by sequencing the V4 region of the 16S rRNA gene using the Illumina MiSeq platform (Illumina Inc., San Diego, CA). The LPSD and CON maintained pH above 6 for the entire experimental period, and the WBD kept pH between 5.2 and 5.6 for 4 h/d, successfully inducing SARA. Digestibility of neutral detergent fiber and crude protein in LPSD were not different from WBD but tended to be lower than CON. Lipopolysaccharide dosing had no effect on pool of VFA concentrations and profiles but decreased bacterial N; the pattern changes of VFA and LPS in LPSD started to increase and be similar to WBD 6 h after LPS dosing. Pool of LPS concentration was around 11-fold higher in WBD and 4-fold higher in LPSD than CON. In the solid fraction, the BCC of LPSD was different from WBD and tended to be different from CON. In the liquid fraction, the BCC was different among treatments. The LPS dosing increased the relative abundance of Succinimonas, Anaeroplasma, Succinivibrio, Succiniclasticum, and Ruminobacter, which are main gram-negative bacteria related to starch digestion. Our results suggest that LPS dosing does not affect pH alone. However, LPS could drive the development of SARA by affecting bacteria and bacterial fermentation. For future studies, samples are suggested to be taken 6 h after LPS dosing in a dual-flow continuous culture system.

Effects of replacing canola meal with solvent-extracted camelina meal on microbial fermentation in a dual-flow continuous culture system.

Camelina is an oil seed crop that belongs to the Brassica family (Cruciferae). Camelina meal is a by-product from the biofuel industry that contains on average 38% crude protein and between 10 to 20% of residual fat, which limits the inclusion levels of camelina meal in dairy cow diets as the main protein supplement. Thus, we conducted a solvent extraction on ground camelina seed on a laboratory scale. The objectives of this study were (1) to assess the effects of replacing canola meal (CM) with solvent-extracted camelina meal (SCAM) in lactating dairy cow diets; and (2) to determine the effects of SCAM on microbial fermentation and AA flow in a dual-flow continuous culture system. Diets were randomly assigned to 6 fermentors in a replicated 3 × 3 Latin square with three 10-d experimental periods consisting of 7 d for diet adaptation and 3 d for sample collection. Treatments were 0, 50, and 100% SCAM inclusion, replacing CM as the protein supplement. Diets contained 55:45 forage:concentrate, and fermentors were fed 72 g of dry matter/d equally divided in 2 feeding times. On d 8, 9, and 10 of each period, samples were collected for analyses of pH, volatile fatty acids (VFA), N metabolism, NH3-N, digestibility, and AA flow. Statistical analysis was performed using the MIXED procedure of SAS (SAS Institute Inc., Cary, NC), and linear and quadratic effects of SCAM inclusion were assessed. Total VFA concentration and pH were not affected by diets. Molar proportion of acetate decreased, whereas molar proportion of propionate increased with SCAM inclusion. Total branched-chain VFA concentration was the least in fermentors fed diet 0, and greatest in fermentors fed diet 50. Digestibility of NDF decreased in fermentors fed SCAM diets, and dry matter, organic matter, and crude protein true digestibility were similar across diets. Concentration of NH3-N linearly decreased, and non-NH3-N linearly increased with SCAM inclusion. Bacterial efficiency (calculated as g of bacterial N flow/kg of organic matter truly digested) tended to be greater in fermentors fed diet 100. Outflow of Arg linearly increased with SCAM inclusion, whereas overall AA flow was not affected by diet. In conclusion, replacing CM with SCAM increased propionate molar proportion and non-NH3-N flow, and decreased NH3-N flow and concentration, which may improve animal energy status and N utilization. Inclusion of SCAM did not change most AA flow, indicating that it can be a potential replacement for CM.

Effect of replacing calcium salts of palm oil with camelina seed at 2 dietary ether extract levels on digestion, ruminal fermentation, and nutrient flow in a dual-flow continuous culture system.

Camelina is a drought- and salt-tolerant oil seed, which in total ether extract (EE) contains up to 74% polyunsaturated fatty acids. The objective of this study was to assess the effects of replacing calcium salts of palm oil (Megalac, Church & Dwight Co. Inc., Princeton, NJ) with camelina seed (CS) on ruminal fermentation, digestion, and flows of fatty acids (FA) and AA in a dual-flow continuous culture system when supplemented at 5 or 8% dietary EE. Diets were randomly assigned to 8 fermentors in a 2 × 2 factorial arrangement of treatments in a replicated 4 × 4 Latin square design, with four 10-d experimental periods consisting of 7 d for diet adaptation and 3 d for sample collection. Treatments were (1) calcium salts of palm oil supplementation at 5% EE (MEG5); (2) calcium salts of palm oil supplementation at 8% EE (MEG8); (3) 7.7% CS supplementation at 5% EE (CS5); and (4) 17.7% CS supplementation at 8% EE (CS8). Diets contained 55% orchardgrass hay, and fermentors were fed 72 g of dry matter/d. On d 8, 9, and 10 of each period, digesta effluent samples were taken for ruminal NH3, volatile fatty acids, nitrogen metabolism analysis, and long-chain FA and AA flows. Statistical analysis was performed using the MIXED procedure (SAS Institute Inc., Cary, NC). We detected an interaction between FA source and dietary EE level for acetate, where MEG8 had the greatest molar proportion of acetate. Molar proportions of propionate were greater and total volatile fatty acids were lower on CS diets. Supplementation of CS decreased overall ruminal nutrient true digestibility, but dietary EE level did not affect it. Diets containing CS had greater biohydrogenation of 18:2 and 18:3; however, biohydrogenation of 18:1 was greater in MEG diets. Additionally, CS diets had greater ruminal concentrations of trans-10/11 18:1 and cis-9,trans-11 conjugated linoleic acid. Dietary EE level at 8% negatively affected flows of NH3-N (g/d), nonammonia N, and bacterial N as well as the overall AA outflow. However, treatments had minor effects on individual ruminal AA digestibility. The shift from acetate to propionate observed on diets containing CS may be advantageous from an energetic standpoint. Moreover, CS diets had greater ruminal outflow of trans-10/11 18:1 and cis-9,trans-11 conjugated linoleic acid than MEG diets, suggesting a better FA profile available for postruminal absorption. However, dietary EE at 8% was deleterious to overall N metabolism and AA outflow, indicating that CS can be fed at 5% EE without compromising N metabolism.

Oxidative stress in older patients with iron deficiency anaemia.

We propose that oxidative damage may play a role in the pathogenesis of iron deficiency anaemia (IDA). Participants were selected from Basic Attention Ambulatory from North of Rio Grande do Sul, Brazil. All subjects were older than 65 years - 17 patients with IDA and primary hypertension and 18 patients with primary hypertension (control group) were included in the present study. We measured antioxidant defenses including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and total glutathione (GSH) by spectrophotometric assays. We also determined protein oxidative damage in haemolysate and plasma by carbonyl assay. We characterized the lipid peroxidation by malondialdehyde (MDA) accumulation. The results show that IDA patients had significantly higher CAT and SOD levels than controls. GPx activity was not different between the groups. Oxidative protein damage was noted in the plasma but not in the haemolysate. A significantly enhanced production of MDA was observed in the serum of IDA patients, as an indication of increased level of auto-oxidizable lipids under oxidative stress. These results support the idea that patients with IDA are subjected to chronic oxidative stress. Therefore it is important that IDA in older persons receives adequate attention in clinical practice and is not considered simply a part of normal aging.

Removal of Cu and Zn from swine raising wastewater using organic filters.

Rice husks, coffee bean skins, sugar cane bagasse, maize cobs, saw dust and fine charcoal dust were evaluated as filters for the removal of heavy metals (Cu and Zn) from the waste water of swine raising installations. The specific mass, pH and the sum of bases and removable acids were determined to characterize each of the filter materials. Each filtering material was placed in a 100 mm diameter, 600 mm long, PVC column to a height of 500 mm under 12,500 N m(-2) of compression. Chemical and physical analyses were determined on effluent samples collected for each 1.5 l up to a total of 15 l. The organic materials reduced the concentration of sediment solids (> 90%), total solids (up to 33%) and Cu (up to 43.6%) of the inffluent but had little or no effect on Zn concentration.

[Transient cortical blindness after cardiac catheterization in a post-surgical coronary patient]. / Cegueira cortical transitória após cateterismo cardíaco em doente coronário operado.

Transient cortical blindness is a known complication after cerebral and vertebral angiography although is a rare complication following cardiac catheterization. In this report, we describe a seventy-six-year-old male patient who had cortical blindness after coronary bypass graft angiography. The development of cortical blindness, in this setting, appears to be an osmotic disruption of the blood-brain barrier which is selective for the occipital cortex. Other hypotheses, such as an immunological reaction to the contrast agent or a direct injection of dye into the vertebral artery system, were considered. The clinical outcome is usually favourable, with vision completely restored within 24-48 hours, as was the case of the patient described in the present report.

Hemipelvectomia: resultados obtidos em dezesseis pacientes operados no hospital do câncer de Pernambuco / Hemipelvectomy: results in 16 patients who underwent surgery at \"Hospital do Câncer de Pernambuco\" - Brazil

Os autores apresentam o resultado do tratamento de dezesseis pacientes portadores de neoplasias malígnas localizada na pelvi, submetidos a reumipelvectomia no Hospital do Câncer de Pernambuco. Em seis casos, 37,5porcemto, foram registrados: um óbito transoperário, três infecçSes de ferida, uma embolia pulmonar e uma recidiva local do tumor. O elevado índice de complicaçSes foi atribído ao estado avançado da doença, quamdo os pacientes procuraram o hospital

Resultados do tratamento de osteossarcoma no Hospital do Câncer de Pernambuco / Results on the treatment de osteosarcoma at the \"Hospital do Câncer\" in Pernambuco-brasil

Os autores apresentam os resultados do tratamento de osteossarcoma em 51 pacientes no Hospital do Câncer de Pernambuco (HCPE), no intervalo de 5 anos. A análise, parte de protocolo para acompanhamento de pacientes com osteossarcoma, consistiu da localizaçÝo do tumor, número de ciclos de quimioterapia pré e pós-operátorio e tratamento cirúrgico. Houve prevalência de sexo masculino com 29 casos (56,9por cento), e a idade média de 12,8 anos. No sexo feminino foi de 14,1 anos. O tumor localizou-se mais frequentemente no fêmur em 28 casos (54,9por cento), dos quais 21 (75por cento) comprometiam a metáfise distal, seguido da tíbia 17 casos (33,3por cento) entre os quais 10 (58,8por cento) se localizavam na metáfise proximal. O úmero, com 5 casos em metáfise proximal representou 9,8por cento dos casos de rádio distal com 1 paciente significou 2,0por cento. Em relaçÝo ao tratamento quimioterápico houve uma média de 4,8 ciclos pré-operatórios e de 4,7 ciclos pós-operatórios. O tratamento cirúrgico mais frequente foi a amputaçÝo com 29 casos (56,9por cento), a cirurgia com preservaçÝo de membro foi realizada em 14 pacientes (27,4por cento)e a preservaçÝo seguida de amputaçÝo, por causa de recidiva local, foi necessária em 5 pacientes (9,8por cento). No intervalo estudado 12 pacientes foram a óbito pela doença (23,5por cento), permaneceram vivos com doença 19 pacientes (37,2por cento) e 20 pacientes (39,2por cento) continuaram vivos sem doença

[The Bland-White-Garland syndrome or an anomalous origin of the left coronary from the pulmonary artery. Apropos a case of a continuous murmur in an adult]. / Síndrome de Bland-White-Garland ou origem anómala da coronária esquerda na artéria pulmonar. A propósito de um caso de sopro contínuo num adulto.

The authors report a case of anomalous origin of the left coronary artery from the trunk of pulmonary artery in an adult without significant symptoms, diagnosed by the presence of a continuous thoracic murmur. Because its low incidence and great mortality in the beginning of life, the appearance in the adult is extremely uncommon, especially without symptoms of cardiac failure, angina pectoris or myocardial infarction. In the present case, the patient was asymptomatic and was submitted to various echocardiograms before the diagnosis was suspected and confirmed with angiography. Surgical treatment was performed successfully with reimplantation of the anomalous vessel in the aorta.

[Free thrombi in the left atrium. Report of a clinical case]. / Trombos livres na aurículo esquerda. A propósito de um caso clínico.

The authors describe a case of a floating thrombus in the left atrium, detected by a 2D echocardiography in a female patient suffering from dilated cardiomyopathy. At the follow-up, it was found that the mass was no longer detected inside the left atrium. This occurrence was not associated to any major embolic phenomena. A transesophageal echocardiographic study revealed the presence of a thrombus in the left atrial appendage.