Reliability of simulated combat tasks performed by Brazilian Air Force cadets.

The Brazilian Air Force (BAF) has developed physical evaluations focused on the demands required in combat scenarios, giving rise to the Simulated Tasks (STs). Therefore, the purpose of the present study was to determine test-retest reliability and investigate learning effects of the five STs established among the BAF. Fifty-six subjects performed five STs three times, after completing a previous familiarisation session. Repeated measures analysis of variance (ANOVA) was used to determine the occurrence of learning effects, and the intraclass correlation coefficient (ICC) was used to identify the reliability of each ST. ANOVA revealed no significant differences in the subject's scores across trials for all the STs, and the ICCs ranged from 0.75 to 0.92 (p < 0.01). In conclusion, this study identified that the five STs showed no learning effects across three successive trials and exhibited high levels of reliability.

Understanding the reliability and learning effects of the STs established among the Brazilian Air Force is crucial for their potential implementation. The subjects performed five STs three times, over the course of seven days. The results highlighted no evidence of learning effects, and high levels of reliability.

Arteritis de takayasu. alternativas terapéuticas y pronóstico a largo plazo / Takayasu arteritis Therapeutic alternatives and long term outcomes

Resumen Se analizaron los resultados del tratamiento quirúrgico y endovascular a 7.5 años, rango intercuartilo (RIC) entre 2.6 y 12.5 años de seguimiento en 34 pacientes con arteritis de Takayasu. Se reali zaron en total 5 cirugías cardíacas centrales y 53 procedimientos vasculares,18 cirugías de bypass (33.9%) y 35 angioplastías (66.1%). Entre los 18 procedimientos quirúrgicos realizados, 6 (33.3%) presentaron eventos, mientras que en los 35 con intervención percutánea hubo 16 eventos (45.7%). La supervivencia actuarial y otras complicaciones vasculares (método de Kaplan y Meier) a 1,3,5 y 10 años fue: 80% (IC 95% entre 74 y 89%), 68% (IC 95% entre 58 y 79%), 65% (IC 95% entre 54 y 76%) y 47% (IC 95% entre 41 y 62%).Tanto la revascularización endovascular como la quirúrgica fueron inicialmente exitosas. En el seguimiento del tratamiento endovascular hubo una alta tasa de eventos con necesidad de revascularización repetida a un mismo vaso en el 41% de los casos. La cirugía tuvo mayor mortalidad en pacientes con valvulopatía aórtica, de aorta ascendente y enfermedad coronaria y carotidea combinada. La arteritis de Takayasu requiere frecuentemente revascularización debido a reestenosis y lesiones de novo. En su evolución alejada, el procedimiento quirúrgico ofreció mejores resultados con menor reestenosis.

Abstract The aim of this study was to describe the long term prognosis of 34 patients with Takayasu arteritis and the results of surgi cal and endovascular treatment. A total of 5 central surgeries and 53 endovascular procedures were performed including 18 bypass surgeries (33.8%) and 35 angioplasties (66.2%). The median follow-up was 7.5 years, in terquartile range [IQR] 2.6-12.5. Among the 18 bypass surgeries 6 (33.3%) had events, while in the 35 patients with endovascular treatment there were 16 events (45.7%). The overall 1-, 3-, 5-, and 10-year death and arterial complication-free survival rates were 80% (95% CI between 74 and 89%), 68% (95% CI between 58 and 79%), 65% (95% CI between 54 and 76%) and 47% (95% CI between 41 and 62%). Both revascularization techniques were initially successful. In long term follow-up there was a high restenosis recurrence rate with endovascular treatment requiring repeated revascularization to the same vessel in 41% of the cases. Surgery had higher mor tality in patients with aortic and ascending aortic valve disease, combined coronary artery disease and carotid disease. In long term follow up Takayasu arteritis frequently requires revascularization and restenosis or new lesions are common. Surgical treatment had better results with less restenosis than angioplasty.

[Takayasu arteritis. Therapeutic alternatives and long term outcomes]. / Arteritis de Takayasu. Alternativas terapéuticas y pronóstico a largo plazo.

The aim of this study was to describe the long term prognosis of 34 patients with Takayasu arteritis and the results of surgical and endovascular treatment. A total of 5 central surgeries and 53 endovascular procedures were performed including 18 bypass surgeries (33.8%) and 35 angioplasties (66.2%). The median follow-up was 7.5 years, interquartile range [IQR] 2.6-12.5. Among the 18 bypass surgeries 6 (33.3%) had events, while in the 35 patients with endovascular treatment there were 16 events (45.7%). The overall 1-, 3-, 5-, and 10-year death and arterial complication-free survival rates were 80% (95% CI between 74 and 89%), 68% (95% CI between 58 and 79%), 65% (95% CI between 54 and 76%) and 47% (95% CI between 41 and 62%). Both revascularization techniques were initially successful. In long term follow-up there was a high restenosis recurrence rate with endovascular treatment requiring repeated revascularization to the same vessel in 41% of the cases. Surgery had higher mortality in patients with aortic and ascending aortic valve disease, combined coronary artery disease and carotid disease. In long term follow up Takayasu arteritis frequently requires revascularization and restenosis or new lesions are common. Surgical treatment had better results with less restenosis than angioplasty.

Se analizaron los resultados del tratamiento quirúrgico y endovascular a 7.5 años, rango intercuartilo (RIC) entre 2.6 y 12.5 años de seguimiento en 34 pacientes con arteritis de Takayasu. Se realizaron en total 5 cirugías cardíacas centrales y 53 procedimientos vasculares,18 cirugías de bypass (33.9%) y 35 angioplastías (66.1%). Entre los 18 procedimientos quirúrgicos realizados, 6 (33.3%) presentaron eventos, mientras que en los 35 con intervención percutánea hubo 16 eventos (45.7%). La supervivencia actuarial y otras complicaciones vasculares (método de Kaplan y Meier) a 1,3,5 y 10 años fue: 80% (IC 95% entre 74 y 89%), 68% (IC 95% entre 58 y 79%), 65% (IC 95% entre 54 y 76%) y 47% (IC 95% entre 41 y 62%).Tanto la revascularización endovascular como la quirúrgica fueron inicialmente exitosas. En el seguimiento del tratamiento endovascular hubo una alta tasa de eventos con necesidad de revascularización repetida a un mismo vaso en el 41% de los casos. La cirugía tuvo mayor mortalidad en pacientes con valvulopatía aórtica, de aorta ascendente y enfermedad coronaria y carotidea combinada. La arteritis de Takayasu requiere frecuentemente revascularización debido a reestenosis y lesiones de novo. En su evolución alejada, el procedimiento quirúrgico ofreció mejores resultados con menor reestenosis.

Short-term effects of wildfire ash exposure on behaviour and hepatosomatic condition of a potamodromous cyprinid fish, the Iberian barbel Luciobarbus bocagei (Steindachner, 1864).

Wildfires are a common phenomenon in Mediterranean regions that is becoming increasingly frequent and severe, causing several environmental concerns, of which ash runoff represents an important source of disturbance for aquatic organisms, in particular for fishes. Studies on the behavioural response of fishes to wildfire ash runoff are scarce and seldom include cyprinid species. The goal of this study was to investigate in a 3-artificial flume channel mesocosm, the behavioural and hepatosomatic condition responses of a native widespread potamodromous fish, the Iberian barbel (Luciobarbus bocagei), previously exposed for 24 h to different concentrations of wildfire ashes: 0.0 g/L (the control, no ash), 1.0 g/L (low concentration) and 2.0 g/L (high concentration). Behavioural parameters included i) routine activity, ii) boldness and iii) shoaling cohesion. The hepatosomatic index (HSI) was further determined to assess the health condition of fish. Significant differences on fish behaviour parameters were detected between the control and the high concentration of ash. Accordingly, i) an increasing proportion of fish were found on resting activity (56.2% vs 30.6% in the control), whereas the proportion of fish on searching behaviour (58.4% in the control) decreased (41.5%); ii) the proportion of bolder individuals was found to decrease (42.5% in the control vs. 29.4%) and iii) the same trend was detected for shoaling cohesion (61.3% in the control to 33.8%, of all fish within a body length of each other). Such differences were paralleled by an increase in the HSI from 1.62% (control) to 2.40% (high concentration). The present study shows that even short duration exposure to ash-loaded runoff can alter fish behaviour and hepatosomatic condition and highlights the need to maintain an unfragmented river network, or, when this is not possible, to prioritize the removal or retrofitting of barriers to increase movement dispersal and provide conditions for species recovery from fire-disturbances.

Tiempo y naturaleza de uso del móvil en estudiantes de la carrera de meicina / Time and Nature of Mobile Phone Usage Medicine Students

Antecedentes: Diversas investigaciones se realizan sobre el tiempo y naturaleza de uso del móvil en estudiantes universitarios pero escasas en el área de la medicina en el siglo de la tecnología. Objetivo: Establecer el tiempo y naturaleza de uso del teléfono móvil en estudiantes de cuarto año de medi-cina de cuarto año A en la Escuela Universi-taria de Ciencias de la Salud de la Universi-dad Nacional Autónoma de Honduras en el Valle de Sula (EUCS/UNAH-VS) en el primer semestre académico del 2017. Pacientes y Métodos: Estudio exploratorio-descriptivo. Población fue de 78, muestra no probabilísti-ca por conveniencia de 38 estudiantes, instrumento de recolección de datos se realizó a través del programa App Usage®que generó los resultados, se evaluaron los datos de frecuencias, porcentajes y medidas de tendencia central en Excel®. Resultados:Los datos reflejaron que el tiempo promedio de uso del móvil por los estudiantes fue de 5 horas 9 minutos (21.5%) del día. El uso se centró en aplicaciones móviles reactivas (distractor) con 4 horas 47 minutos (93%) y en aplicaciones móviles proactivas solo 22 minutos (7%). Conclusiones: Los datos de esta investigación indican que el patrón de uso del teléfono móvil es del 21.5% al día y la naturaleza del uso de los teléfonos celula-res por parte del estudiante de Medicina de cuarto año A de la UNAH-VS es de carácter reactivo o sea como distractor.Artículos OriginalesPALABRAS CLAVEAplicaciones Móviles, estudiantes de medi-cina, Teléfonos celulares...(AU)

Medium-term glycemic control in diabetics before coronary bypass surgery.

The aim of this study was to determine the association between preoperative medium-term (60-90 days) glycemic control, as reflected by glycosylated hemoglobin levels (HbA1c), and the incidence of major complications (mediastinitis, perioperative infarction, heart failure, stroke and kidney failure dialysis) and mortality in diabetic patients undergoing elective coronary artery by-pass graft surgery (CABG). This study suggests that aggressive glycemic control three months before surgery, achieving HbA1c=7% improvement results with less postoperative morbidity and mortality.

Medium-term glycemic control in diabetics before coronary bypass surgery

The aim of this study was to determine the association between preoperative medium-term (60-90 days) glycemic control, as reflected by glycosylated hemoglobin levels (HbA1c), and the incidence of major complications (mediastinitis, perioperative infarction, heart failure, stroke and kidney failure dialysis) and mortality in diabetic patients undergoing elective coronary artery by-pass graft surgery (CABG). This study suggests that aggressive glycemic control three months before surgery, achieving HbA1c ≤ 7% improvement results with less postoperative morbidity and mortality.

El propósito de este estudio fue determinar la asociación entre el control glucémico a mediano plazo, 2-3 meses previos a la cirugía cardiaca, evaluado mediante el dosaje de hemoglobina glicosilada (HbA1c), y la incidencia de muerte y complicaciones mayores (mediastinitis, infarto perioperatorio, insuficiencia cardíaca, accidente cerebrovascular e insuficiencia renal dialítica) en pacientes diabéticos tipo 2. Este estudio sugiere que el control glucémico 3 meses antes de la cirugía en pacientes con diabetes mellitus tipo 2, logrando HbA1c ≤ 7%, mejora los resultados en el posoperatorio observándose menor morbilidad y mortalidad.

A morphological analysis of the transition between the embryonic primitive intestine and yolk sac in bovine embryos and fetuses.

The yolk sac (YS) is the main source of embryonic nutrition during the period when the placenta has not yet formed. It is also responsible for hematopoiesis because the blood cells develop from it as part of the primitive embryonic circulation. The objective of this study was to characterize the transitional area between the YS and primitive gut using the techniques of light microscopy, transmission electron microscopy, and immunohistochemistry to detect populations of pluripotent cells by labeling with Oct4 antibody. In all investigated embryos, serial sections were made to permit the identification of this small, restricted area. We identified the YS connection with the primitive intestine and found that it is composed of many blood islands, which correspond to the vessels covered by vitelline and mesenchymal cells. We identified large numbers of hemangioblasts inside the vessels. The mesenchymal layer was thin and composed of elongated cells, and the vitelline endodermal membrane was composed of large, mono- or binucleated cells. The epithelium of the primitive intestine comprised stratified columnar cells and undifferentiated mesenchymal cells. The transitional area between the YS and the primitive intestine was very thin and composed of cells with irregular shapes, which formed a delicate lumen containing hemangioblasts. In the mesenchyme of the transitional area, there were a considerable number of small vessels containing hemangioblasts. Using Oct4 as a primary antibody, we identified positive cells in the metanephros, primordial gonad, and hepatic parenchyma as well as in YS cells, suggesting that these regions contain populations of pluripotent cells.

Development of bovine embryos derived from reproductive techniques.

Assisted reproduction techniques have improved agricultural breeding in the bovine. However, important development steps may differ from the situation in vivo and there is a high mortality rate during the first trimester of gestation. To better understand these events, we investigated the development of embryos and fetal membranes following fixed-time AI (FTAI), IVF and nuclear transfer (NT). The onset of yolk-sac development was not normal in cloned embryos. Later steps differed from conditions in vivo in all three groups; the yolk-sac was yellowish and juxtaposed with the amniotic membrane. Vascularisation of the chorioallantoic membrane was relatively late and low in NT gestations, but normal in the others. The overall development of the embryos was normal, as indicated by morphology and regression analysis of growth rate. However, NT conceptuses were significantly smaller, with the livers in some embryos occupying the abdominal cavity and others exhibiting heart abnormalities. In conclusion, the yolk-sac and the cardiovascular system seem to be vulnerable to morphogenetic alterations. Future studies will focus on gene expression and early vascularisation processes to investigate whether these changes may be responsible for the high incidence of intrauterine mortality, especially in clones.

Morfologia dos órgãos genitais masculinos e da cloaca da ema (Rhea americana americana) / Morphology of the male genital organs and cloaca of Rhea americana americana

As características morfológicas, macroscópicas e microscópicas, dos órgãos genitais masculinos e da cloaca foram analisados em 23 emas, quatro filhotes (duas semanas), sete jovens (de três a oito meses) e doze adultos (três anos), provenientes da Cooperativa Emas do Brasil, RS, e do CEMAS, Mossoró, RN. Os testículos da ema possuem formato alongado e localizam-se na cavidade celomática, na região intra-abdominal dorsal, com comprimento e larguras médias de 7,6±1,2cm e 2,6± 0,7cm nos adultos; 4,5±1,5cm e 0,9±0,4cm nos jovens; e 0,8±0,3cm, e 0,2±0,1cm nos filhotes. O testículo está envolto pela túnica albugínea e seu parênquima possui túbulos seminíferos irregulares, compostos por epitélio espermatogênico e por células de sustentação, e pelo tecido intersticial, com as células endócrinas intersticiais, tecido conjuntivo frouxo e vasos. Nos adultos observaram-se todas as células da linhagem espermatogênica, enquanto nos jovens com 3 meses, os testículos apresentaram túbulos seminíferos com luz reduzidas, espermatogônias e células de sustentação indiferenciadas. Os ductos eferentes possuem um epitélio cúbico ciliado, enquanto no ducto epididimário o epitélio é columnar. O epidídimo apresentou-se alongado e fusiforme junto a margem medial do testículo. O ducto deferentes apresentou trajeto sinuoso nos adultos, retilíneo nos jovens, convoluto na sua porção média, diminuindo seu formato sigmóide em sua porção caudal, próximo à cloaca. O epitélio é pseudoestratificado e reveste a luz irregular nos adultos e circular nos jovens, mantendo proximidade com o ureter. A cloaca dividiu-se em três segmentos: o coprodeu, o urodeo e o proctodeo. No urodeu os ductos deferentes desembocaram em papilas na parede ventro-lateral, próximo a inserção do falo fibroso. O falo é um órgão fibroso linfático, localizado na parede ventral, no assoalho da cloaca, e apresentou duas porções: uma rígida bifurcada e contorcida, e outra simples espiralada e flexível...

The rhea (Rhea americana americana) is a bird that belongs to the group of the Ratitas, order Rheiforme and family Rheidae. Macroscopic and microscopic morphology of the male genital organ (testes, epididymis, deferent ducts, and phallus) and the cloaca were analyzed in 23 emas, four chicken (2 weeks old), young (3 to 10 months old), and twelve adult ones (3 years old), from Cooperativa Emas do Brasil, RS and from CEMAS, Mossoró, RN. The testis of rhea had elongated shape and were located inside coelomatic cavity, in dorsal region of abdominal cavity, with medium length and width of 7.6±1.2cm and 2.6±0.7cm at adult animals; 4.5±1.5cm and 0.9±0.4cm at young animals; and 0.8±0.3cm, and 0.2±0.1cm at chicken. The testis were recovered by the tunica albuginea and its parenchyma had seminiferous tubules composed by spermatogenic epithelium and by sustentation cells, and also interstitial tissue, with interstitial endocrine cells, connective tissue and vessels. At the adult animals were observed all the cells from spermatogenic lineage, whilst at the youngs with 3 months the seminiferous tubules had a smale lumen with spermatogonia and undifferentiated sustentacular cells. The efferents ductus were composed by a cubic ciliated epithelium, while the epididimydis duct had a columnar epithelium. The epididymis was elongated and fusiform closely to medial testis board. The deferent duct had sinuous stretch at adult animals, rectilineae at young animal, convolute at its medium portion, decreasing its sigmoid shape at caudal portion, next to cloaca. The epithelium was pseudostratified ciliated, irregular lumen at adult animal, and circular at young animal, closely with urether. The cloaca was divided into three segments: coprodeum, urodeum and proctodeum. At urodeum the deferent ducts discharged into papillas at the ventral side wall, next to fibrous phallus's insertion. The phallus was a lymphatic fibrous organ, located at ventral wall, at the cloaca floor...

Morfologia dos órgãos genitais masculinos e da cloaca da ema (Rhea americana americana) / Morphology of the male genital organs and cloaca of Rhea americana americana

As características morfológicas, macroscópicas e microscópicas, dos órgãos genitais masculinos e da cloaca foram analisados em 23 emas, quatro filhotes (duas semanas), sete jovens (de três a oito meses) e doze adultos (três anos), provenientes da Cooperativa Emas do Brasil, RS, e do CEMAS, Mossoró, RN. Os testículos da ema possuem formato alongado e localizam-se na cavidade celomática, na região intra-abdominal dorsal, com comprimento e larguras médias de 7,6±1,2cm e 2,6± 0,7cm nos adultos; 4,5±1,5cm e 0,9±0,4cm nos jovens; e 0,8±0,3cm, e 0,2±0,1cm nos filhotes. O testículo está envolto pela túnica albugínea e seu parênquima possui túbulos seminíferos irregulares, compostos por epitélio espermatogênico e por células de sustentação, e pelo tecido intersticial, com as células endócrinas intersticiais, tecido conjuntivo frouxo e vasos. Nos adultos observaram-se todas as células da linhagem espermatogênica, enquanto nos jovens com 3 meses, os testículos apresentaram túbulos seminíferos com luz reduzidas, espermatogônias e células de sustentação indiferenciadas. Os ductos eferentes possuem um epitélio cúbico ciliado, enquanto no ducto epididimário o epitélio é columnar. O epidídimo apresentou-se alongado e fusiforme junto a margem medial do testículo. O ducto deferentes apresentou trajeto sinuoso nos adultos, retilíneo nos jovens, convoluto na sua porção média, diminuindo seu formato sigmóide em sua porção caudal, próximo à cloaca. O epitélio é pseudoestratificado e reveste a luz irregular nos adultos e circular nos jovens, mantendo proximidade com o ureter. A cloaca dividiu-se em três segmentos: o coprodeu, o urodeo e o proctodeo. No urodeu os ductos deferentes desembocaram em papilas na parede ventro-lateral, próximo a inserção do falo fibroso. O falo é um órgão fibroso linfático, localizado na parede ventral, no assoalho da cloaca, e apresentou duas porções: uma rígida bifurcada e contorcida, e outra simples espiralada e flexível [...](AU)

The rhea (Rhea americana americana) is a bird that belongs to the group of the Ratitas, order Rheiforme and family Rheidae. Macroscopic and microscopic morphology of the male genital organ (testes, epididymis, deferent ducts, and phallus) and the cloaca were analyzed in 23 emas, four chicken (2 weeks old), young (3 to 10 months old), and twelve adult ones (3 years old), from Cooperativa Emas do Brasil, RS and from CEMAS, Mossoró, RN. The testis of rhea had elongated shape and were located inside coelomatic cavity, in dorsal region of abdominal cavity, with medium length and width of 7.6±1.2cm and 2.6±0.7cm at adult animals; 4.5±1.5cm and 0.9±0.4cm at young animals; and 0.8±0.3cm, and 0.2±0.1cm at chicken. The testis were recovered by the tunica albuginea and its parenchyma had seminiferous tubules composed by spermatogenic epithelium and by sustentation cells, and also interstitial tissue, with interstitial endocrine cells, connective tissue and vessels. At the adult animals were observed all the cells from spermatogenic lineage, whilst at the youngs with 3 months the seminiferous tubules had a smale lumen with spermatogonia and undifferentiated sustentacular cells. The efferents ductus were composed by a cubic ciliated epithelium, while the epididimydis duct had a columnar epithelium. The epididymis was elongated and fusiform closely to medial testis board. The deferent duct had sinuous stretch at adult animals, rectilineae at young animal, convolute at its medium portion, decreasing its sigmoid shape at caudal portion, next to cloaca. The epithelium was pseudostratified ciliated, irregular lumen at adult animal, and circular at young animal, closely with urether. The cloaca was divided into three segments: coprodeum, urodeum and proctodeum. At urodeum the deferent ducts discharged into papillas at the ventral side wall, next to fibrous phallus's insertion. The phallus was a lymphatic fibrous organ, located at ventral wall, at the cloaca floor [...](AU)

[Clinical finding and follow-up of chronic constrictive pericarditis]. / Clínica y seguimiento de la pericarditis constrictiva crónica.

The aim of this study was to describe the etiology, clinical findings, diagnostic methods, treatment, outcome and long-term prognosis of 35 patients with chronic constrictive pericarditis (CCP) that were prospectively analyzed according to a pericardial disease protocol performed in our Institution. Etiology of CCP was idiopathic in 24 patients (68%), and specific in 11 (32%). The majority (34 patients, 97%) underwent pericardiectomy. Perioperative mortality was 12% (4/33) no deaths were registered among patients with idiopathic CCP. Median follow-up was 5.6 years (percentile 25-75: 2.4-7.4 years). The cumulative actuarial survival probability was 97% at 1 year (confidence interval [CI] 80% to 99%); 83% at 5 years, (95% CI 65% to 93%); 78% at 7 years, (95% CI 60% to 90%), and 69% at 10 years (95% CI 50% to 84%). In conclusion, nowadays CCP is generally an idiopathic disease with late diagnosis. The clinical course of the disease produces severe symptoms of congestive heart failure. In a 10 years follow-up 2/3 of patients are alive and improved their quality of life. Idiopathic form of pericarditis did not show mortality during early postoperative period.

Clínica y seguimiento de la pericarditis constrictiva crónica / Clinical finding and follow up of chronic constrictive pericarditis

El objetivo de este estudio fue describir la etiología, presentación clínica, métodos diagnósticos, tratamiento, evolución y pronóstico alejado de 35 pacientes con pericarditis constrictiva crónica que fueron evaluados prospectivamente de acuerdo a un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. En 24 (68%) la pericarditis constrictiva fue idiopática y 11 (32%) presentaron etiología definida, realizándose pericardiectomía en 34 (97%). Hubo 4 (12%) muertes intrahospitalarias, todas con etiología definida. La mediana de seguimiento fue de 5.6 años (percentilos 25-75: 2.4-7.4 años). La supervivencia de acuerdo al método de Kaplan-Meier fue de 97% al año (IC 95% 80 - 99%), 83% a los 5 años (IC 95% 65 - 93%), 78% a los 7 años (IC 95% 60 - 90%), y 69% a los 10 años (IC 95% - 50% - 84%). En conclusión, la pericarditis constrictiva crónica es una enfermedad generalmente idiopática, de diagnóstico tardío, cuyo tratamiento es la pericardiectomía. Los pacientes con etiología específica presentaron mayor mortalidad intrahospitalaria. En el seguimiento a 10 años 2/3 de los pacientes están vivos y con mejoría de los síntomas.

The aim of this study was to describe the etiology, clinical findings, diagnostic methods, treatment, outcome and long-term prognosis of 35 patients with chronic constrictive pericarditis (CCP) that were prospectively analyzed according to a pericardial disease protocol performed in our Institution. Etiology of CCP was idiopathic in 24 patients (68%), and specific in 11 (32%). The majority (34 patients, 97%) underwent pericardiectomy. Perioperative mortality was 12% (4/33) no deaths were registered among patients with idiopathic CCP. Median follow-up was 5.6 years (percentile 25-75: 2.4-7.4 years). The cumulative actuarial survival probability was 97% at 1 year (confidence interval [CI] 80% to 99%); 83% at 5 years, (95% CI 65% to 93%); 78% at 7 years, (95% CI 60% to 90%), and 69% at 10 years (95% CI 50% to 84%). In conclusion, nowadays CCP is generally an idiopathic disease with late diagnosis. The clinical course of the disease produces severe symptoms of congestive heart failure. In a 10 years follow-up 2/3 of patients are alive and improved their quality of life. Idiopathic form of pericarditis did not show mortality during early postoperative period.

Derrames pericárdicos crónicos severos idiopáticos / Idiophatic chronic severe pericardial effusion

El objetivo del presente trabajo es determinar la frecuencia la presentación clínica, tratamiento, evolución y pronóstico alejado en pacientes con Derrame Pericárdico Crónico Severo Idiopático (DPCSI)

Discrepancies between the responses to skin prick test to food and respiratory antigens in two subtypes of patients with irritable bowel syndrome.

AIM: To compare the response to skin prick tests (SPTs) to food antigens (FAs) and inhalant allergens (IAs) in patients with two subtypes of irritable bowel syndrome (IBS) and healthy controls. METHODS: We compared the results of SPTs for IAs and FAs in 87 volunteers divided into three groups: diarrhea predominant IBS (D-IBS) Group I (n = 19), constipation predominant IBS (C-IBS) Group II (n = 17), and normal controls Group III (n = 51). RESULTS: Of the 285 tests (171 for FAs and 114 for IAs) performed in Group I we obtained 45 (26.3%) positive responses for FA and 23 (20.1%) for IA. Of the 153 tests for FA in Group II, we obtained 66 (20.1%) positive responses, and of the 102 tests for IA, we obtained 20 (19.6%) positive responses. Of the 459 tests for FA performed in Group III, we obtained 39 (84%) positive responses, and of the 306 for IA, we obtained 52 (16.9%) positive responses. The numbers of positive responses were not significantly different between the three groups, but in the D-IBS group, the number of SPT FA responses differed significantly from those for the other two groups (P > 0.01). CONCLUSION: Despite the small number of cases studied, the higher reactivity to FAs in Group I compared to Groups II and III adds new information, and suggests the presence of a possible alteration in intestinal epithelial function.

Morfologia do ovário da ema (Rhea americana) / Morphology of the ovary in rhea (Rhea americana)

The ovarian morphology of the sexually mature rhea (Rhea Americana) is described. Ovaries from 24 adult rheas in their reproductive age were collected in the slaughterhouse. Follicular diameters (n = 18) were measured and samples (n = 6) were fixed in 10 percent formaldehyde with 0.1M phosphate buffer at pH 7.4 for light microscopy. Results showed that the left ovary occupied the dorsal portion of the celomatic cavity in contact with the cranial portion of the left kidney and the suprarenal gland, being supported in the cavity through the mesovary. On the free surface of the ovary 72.4±17.09 follicles in different phases of development and 30.4±3.65 atretic follicles were observed. The follicles were linked to the ovarian surface by the follicular stalk and had a wide band surrounding its surface, the Stigma folliculare. Histologically, the ovary is constituted by a medulla, composed by connective tissue and vessels, and by a cortex with oocytes and follicles. The follicular wall is composed by the Theca externa and Theca interna, Stratum granulosum and the Zona radiata. The ovary surface is covered by a cubic epithelium, the germinal epithelium, on the connective tissue of the Tunica albuginea. The morphologic characteristics of the ovary of the rhea are due to the egg size in this species and generally similar to other birds.

A morfologia do ovário de emas adultas (Rhea americana) sexualmente maduras foi descrita neste trabalho. Os ovários de 24 fêmeas em fase reprodutiva foram colhidos em abatedouro, tomados dados métricos do diâmetro dos folículos (n = 18) e colhidos fragmentos para microscopia de luz (n = 6) fixados em formol 10 por cento, PBS 0,1M, pH 7,4 para microscopia de luz. Nas emas o ovário esquerdo está desenvolvido, ocupando a porção dorsal da cavidade celomática em contato com a porção cranial do rim esquerdo e a glândula adrenal esquerda, sustentado na cavidade pelo mesovário. Na superfície livre do ovário foram observados em média 72,4±17,09 folículos em desenvolvimento e 30,4±3,65 folículos atrésicos. Os folículos estão unidos à superfície ovariana pelo pedúnculo folicular e os em desenvolvimento apresentam uma cinta na superfície, o estigma folicular, rompida nos folículos atrésicos. Histologicamente, o ovário possui uma medula, com tecido conjuntivo frouxo e vasos sangüíneos e um córtex repleto de oócitos e folículos, cuja parede está constituída pelas tecas externa e interna, estrato granuloso e zona radia-da. No córtex observam-se folículos primordiais, pré-vitelogêni-cos e vitelogênicos. A superfície do ovário está revestida por epitélio cúbico baixo, o epitélio germinativo, o qual está sobre o tecido conjuntivo da túnica albugínea. As características morfológicas do ovário da ema são resultado do tamanho do ovo produzido e em geral semelhante ao de outras espécies de aves.

Morfologia do ovário da ema (Rhea americana) / Morphology of the ovary in rhea (Rhea americana)

The ovarian morphology of the sexually mature rhea (Rhea Americana) is described. Ovaries from 24 adult rheas in their reproductive age were collected in the slaughterhouse. Follicular diameters (n = 18) were measured and samples (n = 6) were fixed in 10 percent formaldehyde with 0.1M phosphate buffer at pH 7.4 for light microscopy. Results showed that the left ovary occupied the dorsal portion of the celomatic cavity in contact with the cranial portion of the left kidney and the suprarenal gland, being supported in the cavity through the mesovary. On the free surface of the ovary 72.4±17.09 follicles in different phases of development and 30.4±3.65 atretic follicles were observed. The follicles were linked to the ovarian surface by the follicular stalk and had a wide band surrounding its surface, the Stigma folliculare. Histologically, the ovary is constituted by a medulla, composed by connective tissue and vessels, and by a cortex with oocytes and follicles. The follicular wall is composed by the Theca externa and Theca interna, Stratum granulosum and the Zona radiata. The ovary surface is covered by a cubic epithelium, the germinal epithelium, on the connective tissue of the Tunica albuginea. The morphologic characteristics of the ovary of the rhea are due to the egg size in this species and generally similar to other birds.(AU)

A morfologia do ovário de emas adultas (Rhea americana) sexualmente maduras foi descrita neste trabalho. Os ovários de 24 fêmeas em fase reprodutiva foram colhidos em abatedouro, tomados dados métricos do diâmetro dos folículos (n = 18) e colhidos fragmentos para microscopia de luz (n = 6) fixados em formol 10 por cento, PBS 0,1M, pH 7,4 para microscopia de luz. Nas emas o ovário esquerdo está desenvolvido, ocupando a porção dorsal da cavidade celomática em contato com a porção cranial do rim esquerdo e a glândula adrenal esquerda, sustentado na cavidade pelo mesovário. Na superfície livre do ovário foram observados em média 72,4±17,09 folículos em desenvolvimento e 30,4±3,65 folículos atrésicos. Os folículos estão unidos à superfície ovariana pelo pedúnculo folicular e os em desenvolvimento apresentam uma cinta na superfície, o estigma folicular, rompida nos folículos atrésicos. Histologicamente, o ovário possui uma medula, com tecido conjuntivo frouxo e vasos sangüíneos e um córtex repleto de oócitos e folículos, cuja parede está constituída pelas tecas externa e interna, estrato granuloso e zona radia-da. No córtex observam-se folículos primordiais, pré-vitelogêni-cos e vitelogênicos. A superfície do ovário está revestida por epitélio cúbico baixo, o epitélio germinativo, o qual está sobre o tecido conjuntivo da túnica albugínea. As características morfológicas do ovário da ema são resultado do tamanho do ovo produzido e em geral semelhante ao de outras espécies de aves.(AU)

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institution’s protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.(AU)

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institutionãs protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.(AU)