Immediate ischemic preconditioning based on somatosensory evoked potentials seems to prevent spinal cord injury following descending thoracic aorta cross-clamping.

OBJECTIVE: Delayed ischemic preconditioning has demonstrated neuroprotective effects in spinal cord ischemia. We investigated the effects of immediate ischemic preconditioning based on somatosensory evoked potentials monitoring in a model of spinal cord injury due descending thoracic aorta occlusion in dogs. METHODS: Twenty-one dogs were submitted to spinal cord ischemia induced by descending thoracic aorta cross-clamping for 45 min. Control group underwent only the aortic cross-clamping (n=7), group A underwent one cycle of ischemic preconditioning (n=7) and group B underwent three equal cycles of ischemic preconditioning (n=7), immediately before the aortic cross-clamping. Ischemic preconditioning cycles were determined by somatosensory evoked potentials monitoring. Neurologic evaluation was performed according to the Tarlov score at 72 h of follow-up. The animals were then sacrificed and the spinal cord harvested for histopathology. RESULTS: Aortic pressures before and after the occluded segment were similar in the three groups. Ischemic preconditioning periods corresponded to a mean ischemic time of 3+/-1 min and a mean recovery time of 7+/-2 min. Severe paraplegia was observed in three animals in Control group, in four in group A and in none in group B. Tarlov scores of group B were significantly better in comparison to the Control group (P=0.036). Histopathologic examination showed severe neuronal necrosis in the thoracic and lumbar gray matter in animals who presented paraplegia. CONCLUSIONS: Immediate repetitive ischemic preconditioning based on somatosensory evoked potentials monitoring seems to protect spinal cord during descending aorta cross-clamping, reducing paraplegia incidence.

Aneurysmal dilation of the reimplant segment of the visceral vessels after thoracoabdominal aneurysm correction.

We present a case of aneurysmal dilation of the aortic residual segment, involving abdominal vessels in corrective surgeries for thoracoabdominal aortic aneurysm, through the identification of risk groups for recurrent dilation, aiming at using a specific operative technique with a branched graft, to prevent aneurysm relapse.

Dilataçäo aneurismática do segmento de reimplante dos vasos viscerais após correçäo de aneurisma toracoabdominal / Aneurysmal dilation of the reimplant segment of the visceral vessels after thoracoabdominal aneurysm correction

We present a case of aneurysmal dilation of the aortic residual segment, involving abdominal vessels in corrective surgeries for thoracoabdominal aortic aneurysm, through the identification of risk groups for recurrent dilation, aiming at using a specific operative technique with a branched graft, to prevent aneurysm relapse

Reversible pulmonary trunk banding. II. An experimental model for rapid pulmonary ventricular hypertrophy.

OBJECTIVE: An experimental model with a reversible pulmonary trunk banding device was developed with the aim of inducing rapid ventricular hypertrophy. The device consists of an insufflatable cuff connected to a self-sealing button. METHODS: The right ventricles of 7 young goats (average weight, 8.7 kg) were submitted to systolic overload and evaluated according to the hemodynamic, echocardiographic, and morphologic aspects. Baseline biopsy specimens were taken from the myocardium for microscopic analysis. The device was implanted on the pulmonary trunk and inflated so that a 0.7 right ventricular/left ventricular pressure ratio was achieved. Echocardiographic and hemodynamic evaluations were performed every 24 hours. Systolic overload was maintained for 96 hours. The animals were then killed for morphologic study. Another 9 goats (average weight, 7.7 kg) were used for control right ventricular weight. RESULTS: The systolic right ventricular/pulmonary trunk pressure gradient varied from 10.1 +/- 4.3 mm Hg (baseline) to 60.0 +/- 11.0 mm Hg (final). Consequently, the right ventricular/left ventricular pressure ratio increased from 0.29 +/- 0.06 to 1.04 +/- 0.14. The protocol group showed a 74% increase in right ventricular mass when compared with the control group. Serial 2-dimensional echocardiography showed a 66% increase in right ventricular wall thickness. There was a 24% increase in the mean myocyte perimeter, and the myocyte area increased 61%. CONCLUSIONS: The device is easily adjustable percutaneously, enabling right ventricular hypertrophy in 96 hours of gradual systolic overload. This study suggests that the adjustable pulmonary trunk banding might provide better results for the 2-stage Jatene operation and for the failed atrial switch operations to convert to the double-switch operation.

Lavado broncoalveolar "versus" biópsia transbrônica em pacientes HIV positivos: análise comparativa de 287 exames / Bronchoalveolar lavage versus transbronchial biopsy in patients infected with the human immunode ficiency virus: comparative analysis of 287 examinations

Foram realizadas 287 broncoscopias em 267 pacientes infectados pelo vírus da imunodeficiência humana (HIV). Em todos os exames procedeu se à coleta do lavado broncoalveolar (BTB) no pulmäo ipsilateral. As amostras foram submetidas a técnicas laboratoriais (microbiologia e estudo histológico) de rotina. A idade dos doentes variou entre 16 e 78 anos (mediana de 37,2),sendo 228 homens(85,4 por cento)e 39 mulheres.Dispnéia foi a queixa principal em 198 casos(69,0 por cento)e o infiltrado intersticial(difuso ou localizado)à radiografia simples foi o achado mais freqüente,em 179 ocasiöes (62,4 por cento). A inspeçäo endoscópica das vias respiratórias foi normal em 246 casos(85,7 por cento).Lesöes mucosas características de sarcoma Kaposi foram verificadas em 12 pacientes(4,2 por cento). O LBA permitiu a identificaçäo de 97 agentes infecciosos,havendo associaçäo de duas etiologias no mesmo doente em 3 casos. A BTB diagnosticou 165 infecçöes (9 das quais associadas ),implicando uma maior positividade que o LBA no diagnóstico de pneumocistose(84 e 51 ,respectivamente) e de citomegalovirose (35 e 0).