The use of internal mammary vein in coronary artery surgery.

Arterial revascularization, and in particular, left internal mammary artery (LIMA), has shown to improve survival of patients with coronary artery disease. Complete revascularization often requires the use of other grafts and saphenous vein graft is still the most common conduit used. Several other types of grafts have been utilized during revascularization, including the radial artery and gastroepiploic artery. It is recognized that its venous structure can change when submitted to long-term blood pressure regimen. We, herein, report left internal mammary vein (LIMV) utilized as a novel conduit for coronary artery revascularization, that was patent after 6 years. LIMV is an easy graft to harvest if the LIMA is dissected as a pedicle. The long-term patency of LIMV is unknown, but its usage could be suggested for elderly patients with peripheral vascular disease, when long graft patency is not required.

Mild hypothermia reduces polymorphonuclear leukocytes infiltration in induced brain inflammation.

Over the last 50 years deep hypothermia (23 degrees C) has demonstrated to be an excellent neuroprotective agent in cerebral ischemic injury. Mild hypothermia (31-33 degrees C) has proven to have the same neuroprotective properties without the detrimental effects of deep hypothermia. Mechanisms of injury that are exaggerated by moderate hyperthermia and ameliorated by hypothermia include, reduction of oxygen radical production, with peroxidase damage to lipids, proteins and DNA, microglial activation and ischemic depolarization, decrease in cerebral metabolic demand for oxygen and reduction of glycerin and excitatory amino acid (EAA) release. Studies have demonstrated that inflammation potentiates cerebral ischemic injury and that hypothermia can reduce neutrophil infiltration in ischemic regions. To further elucidate the mechanisms by which mild hypothermia produces neuroprotection in ischemia by attenuating the inflammatory response, we provoked inflammatory reaction, in brains of rats, dropping a substance that provokes a heavy inflammatory reaction. Two groups of ten animals underwent the same surgical procedure: the skull bone was partially removed, the duramater was opened and an inflammatory substance (5% carrageenin) was topically dropped. The scalp was sutured and, for the group that underwent neuroprotection, an ice bag was placed covering the entire skull surface, in order to maintain the brain temperature between 29.5-31 degrees C during 120 minutes. After three days the animals were sacrificed and their brains were examined. The group protected by hypothermia demonstrated a remarkable reduction of polymorphonuclear leukocytes (PMNL) infiltration, indicating that mild hypothermia can have neuroprotective effects by reducing the inflammatory reaction.

Cisto de pericárdio: uma apresentaçäo incomum / Pericardial cyst: an unusual presentation

Tumores e cistos do coração são raros. A proposta deste artigo é apresentar um caso de cisto pericárdico com aspecto radiográfico atípico, diagnosticado por ecocardiograma transtorácico. A paciente referia sensação de desconforto no hemitórax esquerdo e observou-se, nas radiografias do tórax, a presença de massa contígua ao coração no seio cardiofrênico direito. Os autores também fazem uma suscinta revisão do assunto.