Bovine pericardium retail preserved in glutaraldehyde and used as a vascular patch.

BACKGROUND: In this study we evaluated the performance of bovine pericardium preserved in glutaraldehyde used as a vascular patch. METHODS: Fourteen young pigs, six females and eight males, weighting 10.3 - 18.4 kg were used in our study. We implanted three remnants in each pig, two in the abdominal aorta and one was juxtaposed to the peritoneum. The smooth face (SF) and rough face (RF) of each remnant were implanted turned to the vessel inner portion and one remnant was juxtaposed to the peritoneum. The animals were sacrificed in 4.5 - 8 months after surgery (75 - 109 kg). The remnants were assessed for aorta wall, fibroses formation in inner apposition and calcification related to the face turned to the vessel inner portion. RESULTS: The rough face showed a lower dilatation level compared to the face implanted in adjacent aorta. There was no difference between intensity and/or incidence of graft calcification when the superficies were compared. The bovine pericardium preserved in glutaraldehyde did not show alterations in its structure when implanted with different faces turned to the inner portion of vessel. CONCLUSION: When turned to the inner portion of the vessel, the rough face of the remnant presented a lower dilatation in relation to the adjacent aorta and a better quality of endothelium layer and did not show a difference between intensity and/or incidence of graft calcification.

An experience of vascular access for hemodialysis in Brazil.

BACKGROUND: The analysis of hemodialysis services is relevant for the quality of life of patient. In this study we investigated the profile of vascular access used for hemodialysis patients in our Unit. METHODS: We evaluated 219 patients of both genders aged over 18 years old who have undergone implant or manufacture of vascular hemodialysis access. We excluded patients on renal replacement therapy by peritoneal dialysis. RESULTS: Associated diseases were hypertension and diabetes mellitus. 161 had arteriovenous fistula, with 153 held by the same dialysis and nine of them were still maturing. 27 patients on dialysis used central venous catheter. 148 were indigenous and five were made using polytetrafluoroethylene prosthesis (PTFE). Among the 27 patients with central venous catheters, ten used short-term catheter and 17 used long-term catheter. The most frequent type of fistula use was on the radio distal cephalic, in 85 patients (52.5%), followed by radio cephalic proximal in 26 patients (16%). The number of fistulas in dialysis patients conducted by this kind of therapy ranged from one to ten and in 64 patients (41.83%) fistula was the first and only to be made. Among the fistula for dialysis patients, the highest prevalence was radio cephalic fistula in 111 patients (72.5%) and mean duration of use was 48.1 months, ranging from two months to 17 years. CONCLUSION: Our Unit of hemodialysis is above the limits established by international norms.

Saphenofemoral arteriovenous fistula as hemodialysis access.

BACKGROUND: An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. METHODS: SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. RESULTS: Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. CONCLUSION: SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.

Cardiac baroreflex is already blunted in eight weeks old spontaneously hypertensive rats.

BACKGROUND: The literature did not evidence yet with which age spontaneously hypertensive rats (SHR) start to present baroreflex reduction. We endeavored to evaluate the baroreflex function in eight-week-old SHR. METHODS: Male Wistar Kyoto (WKY) normotensive rats and SHR aged eight weeks were studied. Baroreflex was calculated as the variation of heart rate (HR) divided by the mean arterial pressure (MAP) variation (DeltaHR/DeltaMAP) tested with a depressor dose of sodium nitroprusside (SNP, 50 microg/kg) and with a pressor dose of phenylephrine (PHE, 8 microg/kg) in the right femoral venous approach through an inserted cannula in the animals. Significant differences for p < 0.05. RESULTS: Baseline MAP (p < 0.0001) and HR (p = 0.0028) was higher in SHR. Bradycardic peak was attenuated in SHR (p < 0.0001), baroreflex gain tested with PHE was also reduced in the SHR group (p = 0.0012). PHE-induced increase in MAP was increased in WKY compared to SHR (p = 0.039). Bradycardic reflex responses to intravenous PHE was decreased in SHR (p < 0.0001). CONCLUSION: Eight weeks old SHR already presents impairment of the parasympathetic component of baroreflex.

Aneurisma da artéria coronária esquerda / Left coronary artery aneurism

The coranary artery aneurysm reports are searce in medical literature and habitually related with the atherosclerotic or degeneratives etiology in function of the primary or secundary arteritis. Among the cases described by the literature, the aneurisms it's more in reght coronary artery. The authors report a case of patient with premature precordialgy and miocardic isquemic symptomas. The coronary angiography demonstrated anterior descending artery aneurysm with diagonal branch. Didn't present arteriopaty signs in orthers coraonary organics systems and neither symptomas of the arteritis or sepsis history related with micotic etiology. Electtivally accomplished with cardiopulmonary bypass the aneurysm resection and posteriorly anterior descending artery revascularization with left internal mammary artery graft and first diagonal branch with saphenous vein grafts. The operative elapsed not problems and pacient stayed in hospital for seven days. Actually, it is on tenth month of the attendance with good evolution