Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.

AIMS: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. METHODS AND RESULTS: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. CONCLUSION: In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.

Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients

AIMS: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. METHODS AND RESULTS: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient...

Paciente com sequestro pulmonar intralobar: uma rara anomalia congênita / Patient with intralobar pulmonary sequestration: a rare congenital anomaly

Paciente do sexo masculino, com 51 anos de idade, com história de pneumonias de repetição desde a segunda década de vida. As radiografias de tórax curiosamente demonstravam omesmo padrão radiológico com envolvimento do lobo inferioresquerdo. Foi realizada tomografia helicoidal de tórax, que revelouvaso arterial anômalo emergindo da aorta torácica descendente em direção ao lobo pulmonar inferior esquerdo,caracterizando sequestro pulmonar. Os achados foram confirmados por aortografia torácica, sendo o paciente encaminhado para tratamento cirúrgico.

A 51-year-old male patient had a history of recurrent pneumonia since the second decade of life. Interestingly enough, chest X-rays showed the same radiological pattern with involvement of the left lower lobe. A multislice spiral CT scan of the chest was performed and depicted an anomalous arterial vessel emerging from the descending thoracic aorta towards the left lower pulmonary lobe, characterizing pulmonary sequestration. The findings were confirmed by thoracic aortography, and the patient was referred for surgical treatment.

Serial clinical, colpo-cytological and endocrinological evaluations of Cerdocyon thous bitches from the Rio de Janeiro zoo

Serial clinical, colpo-cytological and endocrinological examinations of two five-year-old females of the crab-eating dog (Cerdocyon thous), from the RIOZOO Foundation in the State of Rio de Janeiro - Brazil, were carried out over a 10-month period. Clinically healthy animals were kept in sand substratum enclosures, located 500m apart from each other. They were each housed with two males. The colpo-cytological technique employed for Cerdocyon thous used methods similar to those developed for domestic bitches. Unlike domestic dogs, blood cells were absent in all phases of the estrus cycle, including the pro-estrus phase. Differentiation of each type of vaginal cells during the estrus cycle phases in this species follows the same patterns shown by domestic bitches. The estradiol and progesterone levels were similar to those occurring in domestic bitches. The progesterone levels reach their maximum (46 ng/ml) around the 10th day of pregnancy. The estradiol analysis demonstrated that, although levels of this hormone could be high at various times throughout the year, mating actually occurs in late winter and in spring. It was impossible to evaluate whether males and females kept in close proximity throughout the entire year would stimulate the production of estradiol, resulting in what would be considered a captivity artifice

Biotecnologia de embriões: III - Otimização do momento da inseminação artificial em fêmeas bovinas superovuladas, para programas de transferência de embriões / Embryos' Biotecnology: III - Optimizing of the Moment of Artificial lnsemination in Superovulated Cows in Embryos Transfer Programs

O objetivo do presente trabalho foi comparar diversos esquemas de inseminação artificial (IA) utilizados em fêmeas bovinas de diferentes raças, doadoras de embriões, de forma a identificar o momento correto da inseminação em programas de transferência de embriões. Computou-se um total de 101 tratamento de indução à superovulação, com FSH-P e sincronização do estro pela aplicação da PGF 2. Os animais foram divididos em quatro grupos para estabelecer-se os esquemas da IA. A partir da detecção do estro, dois grupos de fêmeas sofreram três inseminações com 12h de intervalo (grupo 1) ou duas inseminações com 12h de intervalo (grupo 2), respectivamente esquema 1 e 2. Nos outros dois grupos, onde não se considerou a detecção do estro, as fêmeas sofreram três inseminações, 48, 60 e 72h após a aplicação do agente luteolítico (grupo 3), ou duas inseminações, 48 e 60h após a aplicação do mesmo agente (grupo 4), o que caracterizou os esquemas 3 e 4, respectivamente. A análise das estruturas embrionárias coletadas no 7º dia após a IA, demonstrou não haver diferença significativa (P > 0.05) entre os quatro esquemas de inseminação utilizados, em relação ao número total de embriões recuperados, ao número de embriões transferíveis, ao percentual de embriões degenerados, de não fecundados e de transferíveis. Esses achados indicam que, não foram necessárias mais do que duas inseminações nas fêmeas doadoras superovuladas, para obter-se até 54,98 ± 35,26% de embriões transferíveis, e que o momento da aplicação da PGF 2 pode ser utilizado como um parâmetro confiável, para determinar-se o momento correto da Inseminação Artificial.

The aim of this study was to compare differents artificial insemination (AI) scheduoles used in donors cows, in arder to get the optimun moment of insemination in embryo transfer programs. lt was done 101 treatments of induction to superovulation with FSH-p and estrus sincronization with PGF2. The females were divided in four groups in order to establish artificial insemination schedules. From estrus detection, two groups of donor females were inseminated three times (group 1) or twice (group 2) at 12th intervals, respectively schedule 1 and 2. In the others two groups wich the estrus detection was not considered, the donors were inseminated at 48, 60 and 72h (group 3) or twice, at 48 and 60h (group 4), after luteolitic agent administration, respectively schedules 3 and 4. The statistical analysis of recovered strutuctures on day 7 after AI showed no significant differences (P>0.05) in the four schedules in relation to total number of recovered embryos, transferable embryo number, degenerated embryos, no fertilized and transferable embryo rate. These results indicated that only two A. I. were enough to obtain 54.98 ± 35.26% of transferable embryos and the moment of PGF2 administration may be used as a trustworthy parameter in arder to establish the good time for artificial insemination on cattle.