Identifying a Cardiac Source of Embolism by Transesophageal Echocardiography: Review of a 12-Year Experience

INTRODUCTION: Peripheral embolism is frequently related to a cardiac source of embolism. Transesophageal echocardiography (TEE) is a useful tool for identifying such sources. OBJECTIVES: Our laboratory has gained wide experience in TEE, with a large number of exams performed to search for a cardiac source of embolism. We therefore thought it would be useful to present our experience in the last 12 years following the introduction of the technique. METHODS: This was a retrospective study of 1110 consecutive patients undergoing TEE to search for a cardiac source of embolism, after an embolic event and a transthoracic echocardiogram. RESULTS: The patients' mean age was 53 +/- 14 years, 52% male. There was peripheral embolism in 5% of cases and cerebral embolism in the remainder. The exam identified a potential embolic source in 35.6% of cases, the most frequent diagnoses being intracardiac shunt at the atrial level (9.5%), atrial septal aneurysm (ASA) (6.6%), intracardiac thrombi (6.4%) and atherosclerotic plaques in the thoracic aorta (9.6%). The presence of ASA was frequently associated with patent foramen ovale (27%), which was more frequent in younger patients. Overall, we identified a cardiac source of embolism more often in elderly patients, with a predominance of atherosclerotic plaques in the aorta. ETE was more frequently diagnostic in patients with peripheral embolism, but there were no differences in terms of etiology. CONCLUSIONS: TEE is very useful to search for cardiac sources of embolism, especially in younger patients, in whom causes potentially treatable surgically or percutaneously can be identified. In elderly patients, therapeutic strategy will probably not be changed by the findings (mostly thrombi and atherosclerotic plaques). The presence of ASA and embolic events makes it essential to perform a thorough search by TEE for intracardiac shunts, which are frequently associated

Armazenamento e processamento da macaúba: contribuições para manutenção da qualidade e aumento do rendimento de óleo da polpa.

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Branch xylem density variations across Amazonia

International audienceMeasurements of branch xylem density, Dx, were made for 1466 trees representing 503 species, sampled from 80 sites across the Amazon basin. Measured values ranged from 240 kg m?3 for a Brosimum parinarioides from Tapajos in West Pará, Brazil to 1130 kg m?3 for an Aiouea sp. from Caxiuana, Central Pará, Brazil. Analysis of variance showed significant differences in average Dx across the sample plots as well as significant differences between families, genera and species. A partitioning of the total variance in the dataset showed that geographic location and plot accounted for 33% of the variation with species identity accounting for an additional 27%; the remaining "residual" 40% of the variance accounted for by tree to tree (within species) variation. Variations in plot means, were, however, hardly accountable at all by differences in species composition. Rather, it would seem that variations of xylem density at plot level must be explained by the effects of soils and/or climate. This conclusion is supported by the observation that the xylem density of the more widely distributed species varied systematically from plot to plot. Thus, as well as having a genetic component branch xylem density is a plastic trait that, for any given species, varies according to where the tree is growing and in a predictable manner. Exceptions to this general rule may be some pioneers belonging to Pourouma and Miconia and some species within the genera Brosimum, Rinorea and Trichillia which seem to be more constrained in terms of this plasticity than most species sampled as part of this study