A variant technique for the surgical treatment of left ventricular aneurysms.

OBJECTIVE: To present a surgical variant technique to repair left ventricular aneurysms. METHODS: After anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations. RESULTS: Regarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema. CONCLUSION: The technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

Revascularização cirúrgica do miocárdio com versus sem circulação extracorpórea: O que mostram as evidências? / On-pump versus off-pump coronary artery bypass graft surgery: What do the evidence show?

A proposta da revascularização do miocárdio sem emprego da circulação extracorpórea visa à diminuição da morbimortalidade decorrente dos potenciais efeitos deletérios da circulação extracorpórea. Todavia, embora a maioria dos estudos demonstre que a revascularização sem circulação extracorpórea é factível e forneça resultados similares à operação com circulação extracorpórea, no que se refere à morbimortalidade hospitalar, e pode mesmo diminuir a incidência de alguns eventos, sua eficácia a médio e longo prazo tem sido questionada. Alguns estudos demonstram menor sobrevida em pacientes submetidos à revascularização do miocárdio sem circulação extracorpórea, levantando a hipótese de que a revascularização incompleta e/ou a pior evolução dos enxertos realizados na operação sem circulação extracorpórea em comparação à operação com circulação extracorpórea, observadas em alguns estudos, seriam responsáveis por essa evolução desfavorável.

The main purpose of the off-pump coronary artery bypass surgery is to reduce morbidity and mortality due cardiopulmonary bypass. However, even though many studies have shown that off-pump coronary artery bypass is feasible and provides hospital morbidity and mortality similar to the on-pump coronary artery bypass graft surgery, probably better in some aspects, its long-term results have been questioned, since some trials have shown reduced survival with off-pump coronary artery bypass. It is likely that incomplete revascularization and/or poor graft patency with off-pump coronary artery bypass probably are responsible for such unfavorable outcome.

On-pump versus off-pump coronary artery bypass graft surgery: what do the evidence show?

The main purpose of the off-pump coronary artery bypass surgery is to reduce morbidity and mortality due cardiopulmonary bypass. However, even though many studies have shown that off-pump coronary artery bypass is feasible and provides hospital morbidity and mortality similar to the on-pump coronary artery bypass graft surgery, probably better in some aspects, its long-term results have been questioned, since some trials have shown reduced survival with off-pump coronary artery bypass. It is likely that incomplete revascularization and/or poor graft patency with off-pump coronary artery bypass probably are responsible for such unfavorable outcome.

Synchronous oral paracoccidioidomycosis and esophageal carcinoma.

Paracoccidioidomycosis is the most common deep mycosis in South America and is caused by Paracoccidioides brasiliensis (P. brasiliensis), a thermally dimorphic fungus. Infections usually occur by inhalation of conidia, which more often cause respiratory, mucocutaneous, and lymph nodal changes. Chronic features of this mycosis can mimic diverse infections and malignancies and constitute diagnosis challenges. Squamous cell carcinoma deserves special attention in this setting. We describe the case of a patient with synchronous diagnosis of oral paracoccidioidomycosis and esophageal squamous cell carcinoma. Concomitance of these conditions may be a casual event, but a not fully understood causal relationship can be involved.

Divertículo de Hutch assintomático no adulto / Asymptomatic Hutch diverticulum in adult

O divertículo paraureteral de Hutch é uma alteração incomum do sistema urinário, geralmente associadocom retenção urinária aguda e infecções recorrentes, além de refluxo vesicoureteral. Descrevem os autores um caso de divertículo de Hutch, incidentalmente encontrado em homem etilista de 36 anos, durante a investigação de um episódio de pancreatite aguda. Os estudos de ultra-sonografia e tomografia computadorizada do abdome revelaram uma imagem paraureteral característica de divertículo de Hutch. O paciente não apresentou sintomas urinários, e os exames complementares descartaram retenção urinária e refluxo vesicoureteral. O divertículo foi classificado como congênito, e o paciente tem sido acompanhado no ambulatório da Unidade de Urologia, sem queixas relacionadas ao trato urinário. O propósito deste relato é ilustrar a ocorrência de divertículo de Hutch em adultos assintomáticos.

Hutch paraureteral diverticulum is an unusual abnormality of the urinary system, usually associated with acute urinary retention and recurrent infections, in addition to vesico-ureteral reflux. We describe a case of Hutch diverticulum, which was incidentally found in a 36 year-old alcoholic male during the investigation for an acute episode of pancreatitis. Abdominal ultrasonography and co mputed tomographic studies revealed a paraureteral image typical of the Hutch diverticulum. The patient did not present urinary symptoms, and the complementary evaluation ruled out both urinary retention and vesico-ureteral reflux. The diverticulum was classified as congenital, and the patient has been followed on the Urology clinics without any urinary complain. The aim of this report is to illustrate the occurrence of Hutch diverticulae in asymptomatic adults.